History

The cyst dimensions have no correlation to preoperative symptoms.^[12]

Small cysts in the early stages of their development are frequently (40-87%) asymptomatic and are likely to be recognized on routine radiographic examinations during dental treatment.^{[14, 4, 20, 27, 32, 6, 34, 35, 39]}

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. The pain also can be caused by super infection. About 70% of patients experience a combination of these symptoms. Sometimes, fistula formation or an inability to wear dentures is observed.^{[20, 27, 28]}

Paradoxically, patients with small cysts may have disproportionately severe symptoms, whereas patients with large ones may experience few or no symptoms. In all cases in which there is an expansion of the cyst into nasal cavity, symptoms are more severe.^[12]

A salty taste in the mouth and devitalization of the pulps of associated teeth have been reported.^{[5, 7, 40]}

Physical Examination

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.

Nasopalatine duct cysts 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,^{[6, 41]}whereas bony expansion is noted in only 1.4% of patients.^[6]The literature describes an untreated case that caused destruction of bone and mucosa and movement of teeth, with ensuing disability.^[42]

Usually, the anterior teeth react positively to pulp sensitivity testing. In some cases when the electric pulp test is negative or when endodontic treatment has already been performed in the incisor region, the correct diagnosis is more difficult.^[43]

Causes

The cause of nasopalatine duct cyst is essentially unknown; in most cases nasopalatine duct cysts are idiopathic.^[44]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.^{[14, 45]}

Cases of cyst developed after dental implant placement have been described.^[46]

Differential Diagnoses

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Media Gallery

An ovoid radiolucent area between the central incisor teeth with a poorly defined sclerotic outline can be suspected to be a cyst.
An ovoid, clearly radiolucent area with a sharply defined outline and sclerotic margin that has a bearing on the teeth appendix; secondary draw aside of incisor roots.
An ovoid radiolucent area with a poorly defined sclerotic outline between the central incisor teeth.

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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, Rutgers New Jersey Medical School

Deborah Cleveland, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, South Dakota State Medical Association, Teratology Society, Texas Orthopaedic Association, Wisconsin Medical Society, Southeastern Dermatological Association, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Southern Medical Association, Southern Orthopaedic Association, Southern Society for Pediatric Research, Southern Thoracic Surgical Association, Southwest Pediatric Nephrology Study Group, SWOG, Southwestern Surgical Congress, Special Operations Medical Association, Swedish Medical Association, Sydenham Society, Tennessee Medical Association, Tennessee Radiological Society, Texas Medical Association, Texas Pediatric Society, 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, Rutgers New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jacek C Szepietowski, MD, PhD Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Nasopalatine Duct Cyst Clinical Presentation

History

Physical Examination

Causes

References

Tables

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