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Nasopalatine Duct Cyst

Author: Piotr Kurnatowski, MD, Professor, Department of Otolaryngology, Medical University of Lodz, Poland
Coauthor(s): Deborah Cleveland, DDS, Director of Oral Pathology, Associate Professor, Department of Oral Pathology, Biology and Diagnostic Sciences, University of Medicine and Dentistry of New Jersey; Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Contributor Information and Disclosures

Updated: Mar 25, 2008

Introduction

Background

The nasopalatine duct cyst (NPDC) is a developmental, nonneoplastic cyst that is considered to be the most common of the nonodontogenic cysts. NPDC is one of many pathologic processes that may occur within the jawbones, but it is unique in that it develops in only a single location, which is the midline anterior maxilla.

Pathophysiology

The development of the face and the oral cavity takes place between the fourth and eighth weeks of intrauterine life. The secondary palate is formed during the eighth and 12th weeks. In the midline between the primary and secondary palates, 2 channels (the incisive canals) persist. The palatine processes probably partly overgrow the primary palate on either side of the nasal septum. Thus, the incisive canals represent passageways in the hard palate, which extend downward and forward from the nasal cavity. Just before exiting the bony surface of the hard palate (incisive foramen or incisive fossa), the paired incisive canals usually fuse to form a common canal in a Y shape.1

The fusion of facial processes in the embryologic development of the maxilla results in the formation of a pair of epithelial strands (the nasopalatine ducts) that traverse the incisive canals downward and forward, connecting the nasal and oral cavities. The nasopalatine duct leads from the incisive fossa in the oral cavity to the nasal floor, in which it ends in the nasopalatine infundibulum.2
 
The types of epithelia that line the nasopalatine duct are highly variable, depending on the relative proximity of the nasal and oral cavities. The most superior part of the ducts is characterized by a respiratory-type epithelial lining. Moving downward, the lining changes to cuboidal epithelium. In the most inferior portion closest to the oral cavity, squamous epithelium is the usual type. In addition to the nasopalatine ducts, branches of the descending palatine and sphenopalatine arteries, the nasopalatine nerve, and mucus-secreting glands are present within the incisive canals.1 In some vertebrates (eg, snakes), the nasopalatine duct plays a role in the reception of odorants.3

The nasopalatine ducts ordinarily undergo progressive degeneration; however, the persistence of epithelial remnants may later become the source of epithelia that gives rise to NPDC, from either spontaneous proliferation1,4,5,6 or proliferation following trauma (eg, removable dentures), bacterial infection, or mucous retention.1,5,7,8 Genetic factors have also been suggested.5,9 The mucous glands present among the proliferating epithelium can contribute to secondary cyst formation by secreting mucin within the enclosed structure.10 NPDC can form within the incisive canal, which is located in the palatine bone and behind the alveolar process of the maxillary central incisors, or in the soft tissue of the palate that overlies the foramen, called the cyst of the incisive papilla.11

Frequency

United States

Data concerning the prevalence of NPDCs differ considerably, with rates of 0.08%12 to 33%13 having been reported. NPDCs account for approximately 12% of all jaw cyst tumors.14 They occur in both black and white populations.7

Race

No racial predilection is known.

Sex

Males are affected 1.8-20 times more often than females,10,15,16 although the predilection for males is not so obvious in all studies.5,17,18,19

Age

NPDCs occur over a wide age range (7-88 y), and they also occur in fetuses.7,20 Most patients who are affected are aged 30-60 years.4,21,22,23

Clinical

History

  • Small cysts in the early stages of their development are frequently (40-87%) asymptomatic.7,14,16,17,18,20
  • Large cysts can be responsible for a variety of symptoms, including swelling in the anterior part of the midline of the palate (52-88%), discharge (25%), pain defined as a burning sensation in the anterior part of the maxilla that occasionally radiates into the bridge of the nose, and in a person who wears a dental prothesis, a pressure sensation underneath the prosthesis (20-23%); secondly, tooth movement can occur. About 70% of patients experience a combination of these symptoms. Sometimes, fistula formation or an inability to wear dentures is observed.7,14
  • Paradoxically, patients with small cysts may have disproportionately severe symptoms, whereas patients with large ones may experience few or no symptoms.17,24
  • A salty taste in the mouth and devitalization of the pulps of associated teeth have been reported.11,19,25

Physical

  • Large and more destructive cysts that have perforated the labial and palatal bony plates may present as expansile, fluctuant swellings of the anterior palate and the palate.
  • Extrabony cysts that develop within the soft tissues of the incisive papilla area of the anterior hard palate (called the cyst of the incisive papilla) may present as a translucent or bluish colored, dome-shaped swelling. The clinically apparent discoloration is due to the accumulation of fluid contents within the cyst.
  • NPDCs clinically demonstrate slow and progressive growth, sometimes exceeding 60 mm in diameter.
  • Tooth displacement is a common finding, having been reported to occur in 78% of patients,17,24 whereas bony expansion is noted in only 1.4% of patients.17

Causes

The cause of NPDC is essentially unknown. Trauma, infection, and mucous retention within associated salivary gland ducts have all been suggested as possible pathogenetic factors; however, most believe that spontaneous cystic degeneration of residual ductal epithelium is the most likely etiology.

More on Nasopalatine Duct Cyst

Overview: Nasopalatine Duct Cyst
Differential Diagnoses & Workup: Nasopalatine Duct Cyst
Treatment & Medication: Nasopalatine Duct Cyst
Follow-up: Nasopalatine Duct Cyst
Multimedia: Nasopalatine Duct Cyst
References
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References

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  2. Knecht M, Kittner T, Beleites T, Hüttenbrink KB, Hummel T, Witt M. Morphological and radiologic evaluation of the human nasopalatine duct. Ann Otol Rhinol Laryngol. Mar 2005;114(3):229-32. [Medline].

  3. Halpern M. The organization and function of the vomeronasal system. Ann Rev Neurosci. 1987;10:325-62. [Medline].

  4. Schott TR, Correll RW, Wescott WB. Well-defined radiolucent area involving the anterior maxilla. J Am Dent Assoc. Jan 1985;110(1):86-8. [Medline].

  5. Nortje CJ, Farman AG. Nasopalatine duct cyst. An aggressive condition in adolescent Negroes from South Africa?. Int J Oral Surg. Apr 1978;7(2):65-72. [Medline].

  6. Mermer RW, Rider CA, Cleveland DB. Nasopalatine canal cyst: a rare sequelae of surgical rapid palatal expansion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Dec 1995;80(6):620. [Medline].

  7. Elliott KA, Franzese CB, Pitman KT. Diagnosis and surgical management of nasopalatine duct cysts. Laryngoscope. Aug 2004;114(8):1336-40. [Medline].

  8. Mealey BL, Rasch MS, Braun JC, Fowler CB. Incisive canal cysts related to periodontal osseous defects: case reports. J Periodontol. Jun 1993;64(6):571-4. [Medline].

  9. Shear M. Cysts of the Oral Region. J Wright & Sons; 1983.

  10. Regezi JA, Sciubba JJ. Oral Pathology: Clinical Pathologic Correlations. 3rd ed. Philadelphia, Pa: WB Saunders; 1999.

  11. Gnanasekhar JD, Walvekar SV, al-Kandari AM, al-Duwairi Y. Misdiagnosis and mismanagement of a nasopalatine duct cyst and its corrective therapy. A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 1995;80(4):465-70. [Medline].

  12. Killey HC, Kay LW. Benign Cystic Lesions of the Jaws, Their Diagnosis and Treatment. 2nd ed. New York, NY: Churchill Livingstone; 1977.

  13. Burket LW. Nasopalatine duct structures and peculiar bony pattern observed in the anterior maxillary region. Arch Path. 1937;23:793-800.

  14. Righini CA, Bettega G, Boubagra K, Reyt E. Nasopalatine duct cyst (NPDc): one case report. Acta Otorhinolaryngol Belg. 2004;58(2):129-33. [Medline].

  15. Cabrini RL, Barros RE, Albano H. Cysts of the jaws: a statistical analysis. J Oral Surg. Jul 1970;28(7):485-9. [Medline].

  16. Vasconcelos R, de Aguiar MF, Castro W, de Araujo VC, Mesquita R. Retrospective analysis of 31 cases of nasopalatine duct cyst. Oral Dis. Oct 1999;5(4):325-8. [Medline].

  17. Swanson KS, Kaugars GE, Gunsolley JC. Nasopalatine duct cyst: an analysis of 334 cases. J Oral Maxillofac Surg. Mar 1991;49(3):268-71. [Medline].

  18. Anneroth G, Hall G, Stuge U. Nasopalatine duct cyst. Int J Oral Maxillofac Surg. Oct 1986;15(5):572-80. [Medline].

  19. Bodin I, Isacsson G, Julin P. Cysts of the nasopalatine duct. Int J Oral Maxillofac Surg. Dec 1986;15(6):696-706. [Medline].

  20. Abrams AM, Howell FV, Bullock WK. Nasopalatine cysts. Oral Surg Oral Med Oral Pathol. Mar 1963;16:306-32. [Medline].

  21. Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th ed. Philadelphia, Pa: WB Saunders; 1983.

  22. Hedin M, Klamfeldt A, Persson G. Surgical treatment of nasopalatine duct cysts. A follow-up study. Int J Oral Surg. Oct 1978;7(5):427-33. [Medline].

  23. Robertson H, Palacios E. Nasopalatine duct cyst. Ear Nose Throat J. May 2004;83(5):313. [Medline].

  24. Hertzanu Y, Cohen M, Mendelsohn DB. Nasopalatine duct cyst. Clin Radiol. Mar 1985;36(2):153-8. [Medline].

  25. Terry BR, Bolanos OR. A diagnostic case involving an incisive canal cyst. J Endod. Nov 1989;15(11):559-62. [Medline].

  26. Harris IR, Brown JE. Application of cross-sectional imaging in the differential diagnosis of apical radiolucency. Int Endod J. Jul 1997;30(4):288-90. [Medline].

  27. Pevsner PH, Bast WG, Lumerman H, Pivawer G. CT analysis of a complicated nasopalatine duct cyst. N Y State Dent J. Jun-Jul 2000;66(6):18-20. [Medline].

  28. Hisatomi M, Asaumi J, Konouchi H, Shigehara H, Yanagi Y, Kishi K. MR imaging of epithelial cysts of the oral and maxillofacial region. Eur J Radiol. Nov 2003;48(2):178-82. [Medline].

  29. el-Bardaie A, Nikai H, Takata T. Pigmented nasopalatine duct cyst. Report of 2 cases. Int J Oral Maxillofac Surg. Jun 1989;18(3):138-9. [Medline].

  30. Takagi R, Ohashi Y, Suzuki M. Squamous cell carcinoma in the maxilla probably originating from a nasopalatine duct cyst: report of case. J Oral Maxillofac Surg. Jan 1996;54(1):112-5. [Medline].

  31. Takeda Y. Intra-osseous squamous cell carcinoma of the maxilla: probably arisen from non-odontogenic epithelium. Br J Oral Maxillofac Surg. Dec 1991;29(6):392-4. [Medline].

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Further Reading

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Keywords

NPDC, nasopalatine canal cyst, incisive canal cyst, nonodontogenic cyst

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Contributor Information and Disclosures

Author

Piotr Kurnatowski, MD, Professor, Department of Otolaryngology, Medical University of Lodz, Poland
Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Cleveland, DDS, Director of Oral Pathology, Associate Professor, Department of Oral Pathology, Biology and Diagnostic Sciences, University of Medicine and Dentistry of New Jersey
Deborah Cleveland, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, South Dakota State Medical Association, Southeastern Dermatological Association, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, Southern Medical Association, Southern Orthopaedic Association, Southern Society for Pediatric Research, Southern Thoracic Surgical Association, Southwest Pediatric Nephrology Study Group, Southwestern Oncology Group, Southwestern Surgical Congress, Special Operations Medical Association, State Medical Society of Wisconsin, Swedish Medical Association, Sydenham Society, Tennessee Medical Association, Tennessee Radiological Society, Teratology Society, Texas Medical Association, Texas Orthopaedic Association, Texas Pediatric Society, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Camila K Janniger, MD, Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School
Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Jacek C Szepietowski, MD, PhD, Professor and Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
Disclosure: Stiefel Salary Employment

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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