Bilateral Nasolabial Cyst- a Rare Case Report of Nonodontogenic Cyst

INTRODUCTION

The nasolabial cyst (NC) is a rare non-odontogenic cyst originating in the maxillofacial soft tissue1. It representsabout 0.7% of all cysts in the maxillofacialregion, 2.5% of the non-odontogenic cysts. These cysts unless infected causepainless swelling around the nasal vestibule and upper lip and infrequently lead to nasal stuffiness.2Typically, theyappear as a swelling at canine fossa, upper lip, gingivo-labial sulcus, nasal alae and nasal vestibule. Despite the fact thatthey are soft tissue cysts situated extra‑osseously and sometimes cause bone destruction. The initialdiagnosis and treatment is usually made in early stages because the lesion causes cosmetic problems; very rarely it becomes large in dimensions. Commonly seen in adults, it has peak prevalence in the 4th‑5th decade of life.3 Agreater incidence is seen in females (4:1). It is usually unilateral in occurrence with no predilection in side. However, 11.2% cases have been reported to be bilateral.Although uncommon in occurrence, it is imperative for the clinician to make an accurate diagnosis and provide appropriate treatment.8

CASE REPORT

A 24 year old female patient came to the department of oral & maxillofacial surgery for the assessment of bilateral mass in the region of ala of the nose.(Fig 1)The patient was unable to describe precisely how long the lesion had been present. The lesion was painless and there was no history of epistaxis or nasal dischargeExtraoral examination revealed facial asymmetry with slight elevation of the alanasi and deformation of the left nasolabial sulcus.(Fig 1) On palpation, the lesion was nodular, soft, fluctuant, well circumscribed bilaterally and did not extend beyond the soft tissues.A fullthickness incision was reflected along the crest of maxillary alveolar ridge from canine to canine regionbilaterally(Fig2,3) and blunt dissection was done by periosteal elevator(Fig 4)&exposed two smooth, wellcircumscribed cystic swellings just below the nasal floor. There had been scooping of the anterior maxilla on the left side due to expansion of the cyst. In contrast, morphologyof alveolar bone on right side was not affected.Suturing done with 3-0vicryl. No postoperative complications occurred.(Fig 5)

Fig 2: Intraoperative right cystic swelling

Fig 3: Intraoperatively left cystic

Fig 4: Blunt dissection by periosteal elevator swelling

DISCUSSION

Nasolabial cysts were first described by Zuchercandl in 1892 . They are nonodontogenic masses that can be seen in the maxillofacial area. In the literature, the lesions are name as nasolabial cyst, nasoalveolar cyst and Klesdath tumour.4The lesion is submucosal and extraosseous, it expands via the gingivobuccal sulcus and expands all the soft-tissues outwards. Usually the cysts are seen in the 4th-5th decade of lifetime. The incidence of bilateral cyst is 10% in the literature. There are three theories for the formation of the cyst-

(1) The cyst is formed embryologically by detention cells in the maxilla, medial. and lateral nasal wall.

(2) The cyst is formed embryologically by detention cells from the inferior nasolacrimal channel redundant cells.

(3) The cyst is formed embryologically by detention cells from the inferior nasolacrimal channel endodermal cells .

Exposure to trauma accelerates the formationof the cyst. The differential diagnosis of the cyst must be made with central line cysts, cyst of maxilla, odontogenic cysts, periapical cysts, periapical abscess, periapical granulomas, epidermal inclusion cyst, frunculosis of base of the nose, and neoplasms of base of the nose.5 The safety of the teeth in the nasolabial region is clinically important in differentiating from the other lesions. Radiological examination is important in differential diagnosis of odontogenic and nonodontogenic cysts of the region. We expect no erosion of bone especially in the early stages of the disease6. The diagnosis of the lesion can be made by clinical, radiologic examination andhistopathological examination.The treatment can be made by surgical excision, injection of sclerozing materials in the cyst, and endoscopic marsupialization methods7. Excision of the cyst via the sublabial incision is the most preferred treatment modality with very low recurrence rate and cosmetic reasons. Sublabial incision is much better than external incision especially in terms of cosmetic reasons. Recurrence doesnot happen if the wall of the sac is completely removed.

CONCLUSION

Nasolabial cyst must be kept in mind in differential diagnosis of nasal vestibule, nasal base, and sublabial area. Although uncommon in occurrence, it is imperative for the clinician to make an accurate diagnosis and provide appropriate treatment.

REFERENCES