Surgical Management of Nasopalatine Duct Cyst: A Case Report

Abstract

Nasopalatine duct cyst (abbreviated NPDC) is one of many pathologic processes that may occur within the jaw bones, but it is unique in that it develops in only a single location, which is the midline anterior maxilla [1,2,4]. Nasopalatine duct cysts are the most common non-odontogenic cysts of the mouth, representing up to 1% of all maxillary cysts [5]. These lesions are almost three times frequent in males than in females [6]. The maximum prevalence is between 45 and 60 years of age [7], often mistaken for an enlarged nasopalatine duct, NPDCs are of uncertain origin. The spontaneous proliferation theory appears to be the most likely explanation (a number of studies have reported cystic degeneration in the incisor duct and on the midline of the palate in human fetuses) [8]. NPDCs are normally asymptomatic, constituting casual radiological findings, though sometimes (in 17% of cases) patients report pain due to the compression of structures adjacent to the cyst, particularly when the latter becomes overinfected, or in patients who wear dentures that compress the zone. The more caudal the location of the cyst, the sooner symptoms appears [3,7,15]. In terms of histopathology the epithelium of cysts is very diverse and includes a combination of stratified, squamous, non-keratinized epithelium, false stratified columnar epithelium, stratified columnar epithelium and simple cubic epithelium [8,12]. The connective wall of cyst may contain nasopalatine vessels and nerves as well as the glandular structures [6,15]. The appropriate treatment for these cysts can be enucleation and in order to prevent damage to the nasopalatine nerve the enucleation is done from the side of the palate [4,11]. If the cyst is large and there is a risk of loss of teeth vitality or creation of a nasal fistula in the mouth and sinus, the surgeon may choose the marsupialization method [7,13]. The rate of recurrence of this lesion has been reported 2-30% and malignant changes have also rarely been reported [1, 2, 13, 14]. Here we report the case of a 28-year- old male who developed a nasopalatine duct cyst in the maxillary central incisor region. The aim of this study was to highlight the clinical presentation to describe the radiographic and pathological findings and to discuss surgical management of this entity. A 28-year-old male with a complaint of an asymptomatic, nodular swelling located on the palate between the maxillary right and left central incisors since 6 months came to the Surgical Dentistry Department of Poltava Regional Clinical Stomatological Polyclinic. The swelling was associated with a dull aching intermittent pain. Extraorally there was no detectable abnormality or lymphadenopathy. Intraoral examination revealed a well defined oval shaped bluish swelling measuring approximately 12×15 mm, located posterior to the palatine papilla in the midline. The swelling was fluctuant and non-tender.