Nasopalatine Duct Cyst Clinical Presentation

Updated: Aug 30, 2017
  • Author: Piotr Kurnatowski, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

The cyst dimensions have no correlation to preoperative symptoms. [5]

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. [7, 8, 14, 22, 26, 28, 29, 31, 37]

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. [14, 22, 23]

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. [5]

A salty taste in the mouth and devitalization of the pulps of associated teeth have been reported. [19, 30, 38]

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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, [28, 39] whereas bony expansion is noted in only 1.4% of patients. [28] The literature describes an untreated case that caused destruction of bone and mucosa and movement of teeth, with ensuing disability. [40]

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. [41]

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Causes

The cause of nasopalatine duct cyst is essentially unknown; in most cases nasopalatine duct cysts are idiopathic. [42] 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. [7, 43]

Cases of cyst developed after dental implant placement have been described. [44]

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