A new transnasal approach to endoscopic marsupialization of the nasolabial cyst

Our Experience at Tertiary Medical College: Excision with Sublabial Approach Versus Marsupialization with Transnasal Endoscopic Approach in Patients with Nasolabial Cyst

Rare non-odontogenic cysts of the soft tissue of the midface that form between the nasal vestibule and upper lip are known as nasolabial cysts. Treatment can be accomplished by surgical removal, injection of sclerosing material into the cyst, and endoscopic marsupialization. The aim of this study is to compare the effectiveness of Excision with sublabial approach versus Marsupialization with Transnasal Endoscopic approach in patients with Nasolabial cyst in terms of operating time, recurrence rate, postoperative pain and complications. Our study was Duration based prospective observational study with a Duration of four years from August 2018 till July 2022 with study population inclusive of 30 patients aged between 20 and 70 years who were diagnosed with a unilateral nasolabial cyst on the basis of clinical presentation, anatomical location, and computed tomography (CT) findings at ENT Department of our Tertiary Institution. The study used a randomized, single blind, parallel design with a total of 30 patients, which were randomly allocated to undergo Excision with sublabial approach (group A) in 15 patients (15 nasolabial cysts) and Marsupialization with Transnasal Endoscopic approach (Group B) in 15 patients (15 Nasolabial cysts). In the sublabial approach group, the mean operating time was 91.28 ± 3.1 min, whereas in the transnasal marsupialization group, it was 29.7 ± 3.2 min. These differences were statistically significant (P = 0.003). In the excision with sublabial approach and transnasal endoscopic marsupialization groups, the visual analogue scale (VAS) for postoperative pain was 5.9 ± 1.4 and 3.2 ± 0.6, respectively (P = 0.001). Ten patients in the sublabial approach group and five patients in the transnasal marsupialization group had one or more problems during the follow-up period which disappeared spontaneously within 4 weeks without long lasting issues. There were no recurrence lesions or obstructions of the marsupialized cyst opening in either group, according to physical, endoscopic and computed tomography examinations. Nasolabial cysts can be marsupialized transnasally, which offers many advantages over the more traditional sublabial excision method. Transnasal endoscopic marsupialization has the benefits of a shorter operating time, less postoperative pain, and a low complication rate. Therefore, we propose that Transnasal Endoscopic marsupialization be the treatment of choice for nasolabial cyst, replacing the conventional Excision with sublabial approach.

Sublabial excision versus transnasal endoscopic marsupialization for nasolabial cysts: A systematic review and meta-analysis

OBJECTIVES

To compare the intraoperative and postoperative outcomes of sublabial excision and transnasal endoscopic marsupialization, the two primary surgical approaches for nasolabial cysts.

DESIGN AND SETTING

A comprehensive meta-analysis of studies identified from PubMed, Embase, and the Cochrane Library.

PARTICIPANTS

Patients diagnosed with nasolabial cysts who underwent surgical treatment.

MAIN OUTCOME MEASURES

Operative time, postoperative pain, overall postoperative complications, admission rate, length of hospital stay, use of general anaesthesia, medical costs, and recurrence rate.

RESULTS

The pooled analysis revealed that the transnasal endoscopic marsupialization group had shorter operative time (mean differences [MD], -32.51; 95% confidence interval [CI], -38.52 to -26.51), reduced postoperative pain (MD, -4.25; 95% CI, -7.62 to -0.89), fewer overall postoperative complications (risk difference [RD], -0.68; 95% CI, -0.90 to -0.46), lower admission rates (RD, -0.86; 95% CI, -1.11 to -0.61), shorter hospital stays (MD, -1.74; 95% CI, -2.58 to -0.89), decreased use of general anaesthesia (RD, -0.40; 95% CI, -0.76 to -0.03), and reduced medical costs (MD, -229.69; 95% CI, -338.64 to -120.75). The recurrence rate between the two groups showed no significant difference (RD, -0.01; 95% CI, -0.05 to 0.04).

CONCLUSION

Transnasal endoscopic marsupialization presents as a promising alternative to sublabial excision in the treatment of nasolabial cysts. It offers advantages like reduced operative time, decreased postoperative pain, fewer complications, lower admission rates, shorter hospital stays, diminished need for general anaesthesia, and cost savings. Clinicians can leverage these findings to select the most suitable surgical approach for their patients.

A new transnasal approach of Nd:YAG laser treating nasolabial cysts

This paper is to explore the effectiveness of a new modified transnasal endoscopic marsupialization through Nd:YAG (neodymium: yttrium-aluminum-garnet) laser in treating nasolabial cysts in office. A prospective study was undertaken. Patients who suffered from nasolabial cysts from April 2016 to May 2017 at our hospital were involved. They were all treated with Nd:YAG laser transnasal endoscopic marsupialization. All patients were treated in the outpatient treatment room under local anesthesia. The patients ranged in age from 27 to 82 years, with an average age of 45 years. We made the diagnosis by the anatomical site, radiological imagings, and histopathology of the cyst. A total of 12 consecutive patients (men, n = 2; women, n = 10) with nasolabial cysts were involved in this study. Of the 12 patients, 6 were on the left and 8 were on the right side, and 2 had bilateral nasolabial cysts. All patients returned to clinic at 1, 6, and 36 months after treatment. At the follow-up time, none of the patients has mucus accumulation in the sinus or cyst recurrence, except for one patient who received treatment twice. No complications and recurrence during follow-up. In this study, we find that transnasal endoscopic marsupialization through Nd:YAG laser in treating nasolabial cysts is relatively effective, especially for patients who do not want to be hospitalized or treated under general anesthesia.

The feasibility of intranasal endoscopic microwave ablation on the removal of nasolabial cyst: Preliminary case series

OBJECTIVE

The aim of this study was to investigate the clinical effect of the removal of nasolabial cyst via intranasal endoscopic microwave ablation (MWA).

METHODS AND MATERIALS

The patients with nasolabial cyst were ablated through intranasal endoscopic MWA. Postoperative pain intensity was measured via visual analogue scale (VAS), post-operative complications were recorded.

RESULTS

Of the 31 patients with unilateral nasolabial cyst, the main complaint was a gradually increasing mass in the nasal alar and upper lip, other complaint included nasal obstruction (11/31,35.5%), localized pain (21,67.7%), and erythema (13/31,41.9%). All 31 patients were successfully treated with the intranasal endoscopic ablation technique in outpatient. The mean ablation duration was 5.86 ± 0.71 min. The mean VAS pain score was 2.36 ± 1.08 on postoperative. None of infection occurred. All the patients complained of mild numbness in the upper lip with an average last duration of 28.5 ± 7.9 h in patients. In addition, 4 (12.9%) patients had facial/perinasal swelling, acid bilge of maxillary teeth in 7(22.6%), and toothache in one (3.2%). The patients were followed up for 12 months without recurrence and oronasal fistula. The nasolabial cyst had integrated into a part of the nasal cavity.

CONCLUSIONS

The intranasal endoscopic MWA is feasible and alternative to conventional transoral sublabial approach for removal of the nasolabial cysts in outpatient.

An atypical presentation of a bilateral nasolabial cyst: a case report

The nasolabial cyst is a rare, non-odontogenic, soft tissue cyst that develops submucosally in the anterior nasal floor. This cyst accounts for 0.7% of all non-odontogenic cysts. Bilateral nasolabial cyst represents only 10% of the cases. This cyst originates from the remnants of embryonic nasolacrimal duct tissue. Generally, patients present with swelling and facial deformity and rarely local pain. The definite diagnosis should be based on clinical, radiological and above all histopathologic findings. The treatment is enucleation of the cystic tissue. Following is a case report of a bilateral nasolabial cyst in a 40-year-old woman who presented with a chronic nasal obstruction.

A modified longitudinal incision via transoral sublabial approach for removal of the nasal vestibular cyst: a clinical observation

OBJECTIVE

The aim of this study was to investigate the clinical effect of the removal of nasal vestibular cysts through a modified longitudinal incision via a transoral sublabial approach.

METHOD

In 28 cases, a nasal vestibular cyst was removed through a modified longitudinal incision via a transoral sublabial approach. A visual analogue scale score was used to evaluate the numbness of the nasal alar and upper lip. Post-operative complications were recorded. Medical photographs were used for assessment.

RESULTS

For all patients, incisions reached clinical primary healing one week after surgery. All patients were free of post-operative haematoma, infection, oronasal fistula and malformation. In the first week and the first month after surgery, numbness of the nasal alar and upper lip was recorded in few cases. The patients were followed up for 2-57 months without recurrence.

CONCLUSION

Removal of nasal vestibular cysts via a transoral sublabial approach with a modified longitudinal incision is a minimally invasive and simple surgical method with few complications and a quick recovery.

Surgical treatment of nasolabial cysts in a single institute

OBJECTIVES

To analyse the results of treatment for nasolabial cysts according to whether an intraoral sublabial or endoscopic transnasal approach was used, and to determine the recent surgical trend in our hospital.

METHODS

Twenty-four patients with a histopathologically and radiologically confirmed nasolabial cyst between January 2010 and December 2017 were enrolled in this study.

RESULTS

Nasolabial cysts were predominant in females (91.7 per cent) and on the left side (54.2 per cent). Treatment involved an intraoral sublabial approach in 12 cases (48.0 per cent) and a transnasal endoscopic approach in 13 cases (52.0 per cent). In 13 cases (52.0 per cent) surgery was performed under local anaesthesia, while in 12 cases (48.0 per cent) it was conducted under general anaesthesia. The most common post-operative complications were numbness of the upper lip or teeth (n = 9, 36.0 per cent). Only one patient (4.0 per cent), who underwent a transnasal endoscopic approach, experienced a reoccurrence.

CONCLUSION

Surgical resection through an intraoral sublabial or transnasal endoscopic approach is the best treatment for a nasolabial cyst, showing very good results and a low recurrence rate. The recent surgical trend in our hospital is to treat nasolabial cysts using a transnasal endoscopic approach under local anaesthesia.

Surgical Technique of Transoral Marsupialization for the Treatment of Nasopharyngeal Branchial Cysts

Objectives

Nasopharyngeal branchial cysts (NBCs) are derived from a remnant of the branchial apparatus and originate from the lateral wall of the nasopharynx. Total excision of these cysts was the standard treatment in the past. We present a simpler and less invasive approach for NBC treatment, involving marsupialization, and report on its effectiveness and advantages.

Methods

The surgical approach was transoral. A circular incision 2 to 3 cm in diameter was made directly through the inferior wall of the cyst. After the NBC was drained, its opening was widened with scissors. A disk of oropharyngeal mucosa and the connecting inferior wall of the cyst were excised together. The cut edges of the inner lining of the cyst and the oropharyngeal mucosa were approximated with sutures.

Results

All 4 patients were female. One patient was observed because of poor cardiovascular health, the 3 patients who were managed surgically underwent successful transoral cyst marsupialization. The mean follow-up period was 21 months (range, 8 to 40 months). No obvious postoperative complication or recurrence was noted.

Conclusions

Transoral marsupialization is a simple, effective, and less invasive method for treatment of NBCs.

Endoscopic Laser Anterior Commissurotomy for Anterior Glottic Web: One-Stage Procedure

Objectives

The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation.

Methods

Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break “alley” between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice recordings.

Results

All 20 patients had anterior glottic webs ranging from 11 % to 64% of the length from the anterior commissure to the vocal process. None of the patients developed restenosis at the anterior commissure of a severity similar to that of the initial lesion during follow-up (mean, 13 months; range, 3 to 44 months). All patients except 1 reported satisfaction with their voice improvement. Outcome analysis revealed that partial re-formation of the web was noted in 4 patients.

Conclusions

One-stage, endoscopic laser anterior commissurotomy was effective and relatively safe for removing glottic webs, for preventing anterior glottic web re-formation, and for improving vocal fold performance among our patients.

[The nasolabial cyst]

The authors present the clinical observation of the nasolabial cyst together with the concise overview of the relevant literature and terminology, etiology and pathogenesis of this condition.

Bilateral nasolabial cysts - case report and review of literature

Nasolabial cyst is a non-odontogenic, extraosseous, soft tissue cyst, commonly unilateral, located in the nasolabial fold. Bilateral nasolabial cysts are of rare occurrence. This case report describes the multimodality imaging appearance of bilateral nasolabial cysts with a review of literature.

Nasolabial Cyst Associated with Odontogenic Infection

The nasolabial cyst or Klestadt cyst is a relatively uncommon nonodontogenic cyst that develops in the nasal alar region; it has uncertain pathogenesis. This lesion has slow growth and variable dimensions and is characterized clinically by a floating tumefaction in the nasolabial fold area around the bridge of the nose, causing an elevation of the upper lip and relative facial asymmetry. Diagnosis is primarily made clinically; if necessary, this is complemented by imaging. This paper reports the case of a 39-year-old male patient who complained of pain in the right upper premolar region and poor aesthetics due to a firm tumor in the right wing of the nose. Initially, this was thought to be due to an odontogenic abscess; however, the differential diagnosis was that a nasolabial cyst was communicating with the apex of teeth 14 and 15. Surgical treatment was carried out, followed by histopathological examination and concomitant endodontic treatment of the teeth involved.

Nasolabial cysts: A systematic review of 311 cases

OBJECTIVES/HYPOTHESIS

Nasolabial cysts are rare nonodontogenic cysts arising commonly in the nasal alar region. Intraoral sublabial resection of nasolabial cysts is considered the standard treatment modality. In the past 16 years, transnasal endoscopic marsupialization has emerged as an alternative approach for these lesions. A systematic review on this entity was performed to evaluate management and outcomes.

DATA SOURCES

PubMed/MEDLINE Database.

METHODS

A search of literature including nasolabial cysts, nasoalveolar cysts, and Klestadt's cysts was performed using the PubMed/MEDLINE database. Parameters regarding presentation, treatment, imaging, histology, and complications were extracted and subsequently analyzed.

RESULTS

Seventy-nine articles with 311 patient cases were included in this analysis. In cases reporting location, nasolabial cysts occurred 46.9%, 37.5%, and 10.9% on the left, right, and bilaterally, respectively. The most common presenting complaint was facial swelling in 168 out of 237 patients (70.9%). Computed tomography was the most commonly employed imaging study (n = 170). Surgical excision of nasolabial cysts was performed using an intraoral sublabial approach in 184 patients. Seventy-nine patients underwent endoscopic transnasal marsupialization. The most common complication following surgical treatment of nasolabial cysts was postoperative facial/perinasal swelling. Three and two recurrences were reported in the sublabial excision group and transnasal marsupialization group, respectively. Mean follow-up time was 20.0 months.

CONCLUSIONS

Endoscopic transnasal marsupialization is a relatively new alternative to intraoral sublabial resection of nasolabial cysts, with similar efficacy. The rates of postoperative swelling, pain, and recurrence are similar in both groups.

Nasoalveolar cyst: an enigma for the dentist

A nasoalveolar cyst is a rare, non-odontogenic soft tissue cyst encountered in the anterior maxillary labial sulcus as an asymptomatic soft tissue swelling. Often, patients with these cysts report them to the dental clinic where they are mistaken for odontogenic lesions by the dental surgeon, especially if concomitant dental problems are present. They cannot be detected by routine conventional dental radiography as they are peripheral, lying within the mucosa thereby posing a diagnostic challenge. We document a case of a 47-year-old woman with a nasoalveolar cyst.

A modified intranasal endoscopic excision for nasal vestibular cyst in China

This study aimed to improve the surgical removal procedure for nasal vestibular cysts. Twenty-three patients with nasal vestibular cysts underwent surgical removal of the cyst via a transoral sublabial approach and another 30 patients via a modified intranasal endoscopic excision method. The 30 patients were treated with local anesthesia and the roof of the cyst, which was firmly attached to the mucous membrane of the anterior floor of the nasal cavity, was removed transnasally with microdebrider. Bleeding of the opening was stopped by electric coagulation without nasal packing. Among the 30 consecutive patients who underwent the modified surgical procedure, all patients were successfully treated. The mean duration of surgery was 5.7 ± 2.6 min. The mean estimated blood loss was 3.5 ± 2.1 ml. All patients were outpatients. The mean hospital stay was 1 h. The mean total cost was <euro>140. The visual analog scale scores of postoperative pain, pressure and nasal obstruction were 1, 0 and 1, respectively. The incidence rate of postoperative lip swelling or numbness was 0 %. Postoperative endoscopic findings revealed that the cyst was replaced by an air-containing sinus with a persistent opening at the anterolateral nasal floor. There was no recurrence during a mean follow-up of 18 months. The modified intranasal endoscopic excision is a simple, less invasive, low-cost and effective surgical procedure for the treatment of nasal vestibular cysts. It might change the pattern of treatment for nasal vestibular cysts in China.

Diagnosis and management of bilateral nasolabial cysts

Nasolabial cysts are painless, submucosal, non-odontogenic jaw cysts presenting as soft tissue swellings in the maxillary anterior mucolabial fold lateral to midline, leading to elevation of nasal ala. Present case documents bilateral nasolabial cysts in a 69-year-old Asian female patient. In the present case, extraoral swelling of maxillary lip and elevation of nasal ala was observed on right side of the face. Intraorally, soft and fluctuant bilateral cysts were observed. Straw-colored fluid was aspirated from the right cyst. Radiographically, erosion of bone in a “cupping” fashion was observed in the region of left cyst. The cysts were enucleated using intraoral approach. Histopathology of the right-sided cyst revealed a cystic cavity lined by stratified squamous cells along with a few mucosal cells. At few places, stratified squamous and pseudostratified columnar epithelia with many cilia and goblet cells were also evident. Capsule was loosely arranged with fibrous tissue and chronic inflammatory infiltrate. Left-sided cystic specimen showed two or more layered stratified squamous lining epithelium with thin capsule. Diagnosis of bilateral nasolabial/nasoalveolar cysts was confirmed.

The Nasolabial Cyst: A Nonodontogenic Oral Cyst Related to Nasolacrimal Duct Epithelium

Nasolabial cysts are interesting, relatively uncommon benign extraosseous maxillary lesions. We review current knowledge about epidemiology, symptoms, imaging modalities, pathogenesis, histopathologic and ultrastructural features, treatment options, and prognosis. Nasolabial cyst lining epithelium is characteristically composed of a basal layer of cuboidal cells and a luminal layer of columnar secretory cells with interspersed mucous goblet cells. In addition, areas of multilayered epithelium and squamous metaplasia may be seen. The cyst stroma is characterized by collagen-rich fibrovascular tissue with variably admixed chronic inflammatory cells. Furthermore, to our knowledge, we report the first example of immunohistochemical protein expression profiling of nasolabial cyst lining epithelium, discovering that basal layer cells express p63 and cytokeratin 5/6, while goblet cells express MUC-2 and MUC-5AC mucins, supporting the notion that nasolabial cysts can be understood as hamartomatous, locally expansile remnants of distal nasolacrimal duct development.

Nasolabial cyst

Nasolabial cyst is a rare nonodontogenics, soft-tissue cyst occurring in the sublabial area and anterior maxillary region. The patient usually presents with a slowly enlarging asymptomatic swelling. They are usually diagnosed in early stages because of cosmetic problems. In our paper we report a nasolabial cyst of a 53-year-old man and discuss the diagnosis, differential diagnosis, and treatment in the light of the literature.

Marsupialisation and strap muscle transposition laryngoplasty for vocal cysts with vocal fold atrophy

Objectives:

Vocal cysts with fold atrophy often result in more severe glottal incompetence than vocal cysts along during phonation. Although total excision or marsupialisation are reliable treatments for vocal fold cysts, any post-operative vocal deficit with significant glottal gap will need further treatment. This study aimed to evaluate the efficacy of combined treatment consisting of marsupialisation of the cyst immediately followed by strap muscle transposition laryngoplasty.

Method:

Under direct laryngomicroscopy, microscissors were used to make a disc-shaped incision encircling the equator of the cyst. After marsupialisation of the cyst, a simultaneous medialisation laryngoplasty with strap muscle transposition was performed.

Results:

Seven patients with vocal cysts and marked vocal fold atrophy were included in the study. After surgery, subjective improvement in voice quality was reported by all patients. Patients' glottal incompetence and vocal performance were markedly improved.

Conclusion:

Marsupialisation is a simple and effective surgical technique for vocal fold cysts. For cases of vocal cysts with marked vocal fold atrophy, marsupialisation followed by medialisation laryngoplasty with strap muscle transposition may be considered.

Microdebrider-assisted endoscopic marsupialization for the nasolabial cyst: Comparisons between sublabial and transnasal approaches

BACKGROUND

The incidence of nasolabial cysts is very low. Simple excision through a sublabial approach is the treatment of choice. The aim of this study was to evaluate the microdebrider as a tool in transnasal endoscopic marsupialization for nasolabial cysts and compare it with conventional instruments and a sublabial approach for cyst removal.

METHODS

Retrospective chart review of 30 patients (31 cysts) with a mean age of 46.9 years received surgical treatments for nasolabial cysts. We performed three types of surgical procedures including the sublabial approach (10 cysts), conventional transnasal marsupialization (13 cysts), and microdebrider-assisted marsupialization (8 cysts).

RESULTS

Patients that received surgery with the sublabial approach experienced significant increases in operation time, blood loss, and hospitalized time compared with those treated with transnasal marsupialization. However, the number of postoperative stoma stenoses was higher for conventional transnasal marsupialization (two cases). No recurrences or other postoperative complications were found during the follow-up.

CONCLUSION

The transnasal marsupialization of nasolabial cysts has remarkable benefits compared with sublabial cyst excision during operation. Microdebriders can be used safely and effectively in endoscopic marsupialization without stoma stenosis.

Transnasal endoscopic marsupialization of bilateral nasoalveolar cysts

Nasoalveolar cysts are uncommon nonodontogenic and developmental cysts with an uncertain pathogenesis. This cyst has been reported to occur bilaterally in 10-11% of cases. This case report describes a 45-year-old woman in whom the clinicopathologic findings were consistent with bilateral nasoalveolar cysts. The authors report a new, less invasive method for transnasal endoscopic marsupialization of bilateral nasoalveolar cysts. Transnasal endoscopic marsupialization has benefits for the treatment of bilateral and unilateral nasoalveolar cysts.

Comparison of Conventional Excision via a Sublabial Approach and Transnasal Marsupialization for the Treatment of Nasolabial Cysts: A Prospective Randomized Study

Objectives

Surgical excision via a sublabial approach is considered the standard treatment for nasolabial cysts. Although transnasal marsupialization has been proposed as an alternative method, no prospective study has compared the effectiveness of these techniques. We thus compared the surgical procedure, operating time, postoperative pain, complications, and recurrence rate between the two surgical methods.

Methods

Twenty patients diagnosed with nasolabial cysts were allocated randomly into two groups according to the surgical technique. In the sublabial approach group, the cysts were excised completely using a sublabial approach, while in the transnasal marsupialization group, the cysts were marsupialized transnasally under the guidance of nasal endoscopes. The pure operating time was measured and postoperative pain was evaluated using a visual analog scale. Complications after the procedure were assessed and recurrence was determined according to the clinical symptoms and postoperative radiologic findings.

Results

The transnasal marsupialization group had significantly shorter operating times, less postoperative pain, lower complication rates, and shorter duration of side effects than the sublabial approach group. No recurrence occurred in either group after a 1-yr follow-up period.

Conclusion

Although both methods are effective for treating nasolabial cysts, the transnasal marsupialization of nasolabial cysts has many benefits over the conventional sublabial approach. Therefore, we propose that transnasal marsupialization be the treatment of choice for nasolabial cysts.

Marsupialization of Vocal Fold Retention Cysts: Voice Assessment and Surgical Outcomes

Objectives:

Although total excision remains the standard treatment for vocal fold retention cysts, postoperative deficits and damage to the vocal folds still occur. Marsupialization is a more conservative technique and can prevent these complications.

Methods:

In this prospective clinical series, 25 patients underwent the marsupialization procedure. Under a direct laryngomicroscope, the cystic wall margin was retracted medially with microforceps. An incision was made with microscissors encircling the equator of the cyst. The cyst contents drained from the cystic cavity when the capsule was sectioned. For 7 patients with concomitant marked vocal fold atrophy, strap muscle transposition laryngoplasty was simultaneously performed.

Results:

All patients had complete preoperative and postoperative voice parameter analyses. A subjective improvement in voice quality was reported by 23 of the 25 patients (92%). A small recurrent vocal fold cyst was detected in 1 patient. Small vocal fold deficits and sulcus vocalis were detected in 2 and 4 patients, respectively. Only 1 patient described a worse voice after operation. No other complications were noted.

Conclusions:

Marsupialization of vocal fold retention cysts is a simple, relatively safe, and effective surgical treatment. Voice improvement, a low incidence of recurrence, and minimal vocal fold deficits demonstrate the validity of this technique. Marked preoperative vocal fold atrophy or postoperative glottal gap can be managed with medialization laryngoplasty.

Report of rare bilateral nasolabial cysts

PURPOSE

Nasolabial cysts are usually unilateral and are quite rare, while bilateral cysts are even rarer.

PATIENT AND METHOD

Our report concerns a 48-year-old female with bilateral nasolabial cysts. After many years of misdiagnosis she was finally referred to our clinic with a subnasal swelling of unknown origin.

RESULT

Evaluation of the patient's medical history, clinical examination and of a previous CT scan led to the diagnosis of a nasolabial cyst, which was later confirmed by histological examination. Treatment involved the surgical excision.

CONCLUSION

A complete surgical excision is recommended using a sublabial approach as the treatment of choice, although transnasal endoscopic marsupialization seems to be a simple and effective alternative. It has been shown that after successful marsupialization, the nasolabial cyst is converted to an air-containing paranasal sinus.

Nasolabial cyst: diagnostic and therapeutical aspects

Nasolabial cyst is a rare lesion situated behind the ala nasi, extending backwards into the inferior nasal meatus and forward into the labio-gingival sulcus.

Aim

We present our case of a nasolabial cyst, with the purpose of discussing clinical presentation, diagnosis and the more suitable surgical techniques to treat this disorder.

Materials and methods

A retrospective study of eight patients with diagnosis of nasolabial cyst, carried out in the period of january/2000 to december/2006. The diagnosis was suggested by otorhinolaryngology exam and computer tomography. All patients were submitted to surgical treatment (enucleation) and definitive diagnosis was confirmed by histopathology.

Results

Predominant symptoms were nasal obstruction, swelling in the nasal vestibule region and local pain. Patients had had symptoms for a median of 26.2 months. CT scan was performed in all patients, showing a well outlined cystic lesion with bone remodeling in some cases. Median sizes of the cysts were 2.18cm. There was no evidence of recurrence during a mean follow-up of 19.5 months.

Conclusion

Nasolabial cysts are rare lesions. Common presentation is a well-confined swelling, local pain and nasal obstruction. Enucleation is the treatment of choice with low recurrence rate.

Nasolabial cysts: clinical features, diagnosis, and treatment

The aim of this study was to review our experience, examine the clinical and pathological features of nasolabial cysts, and to provide a basis for the diagnosis and treatment in an Asian population. We made a retrospective review of patients with nasolabial cysts who were treated at the Department of Otolaryngology, Tan Tock Seng Hospital between January 1999 and December 2004. Clinical data, presenting symptoms, clinical features, pathological findings, preoperative investigations, treatment, and outcome were analysed for each case. We found 17 patients with nasolabial cysts. The findings of adult onset, higher incidence among women and preponderance on the left side confirmed current opinion. The clinical diagnosis of nasolabial cyst was accurate in all cases. Preoperative computed tomograms (CTs) done for one patient did not alter the management. All patients had the cysts excised completely through a sublabial incision. Breaches of the nasal vestibular mucosa healed spontaneously without repair. Histopathological examination showed that cysts were lined with pseudostratified columnar (n=9), stratified squamous (n=4), mixed respiratory and squamous epithelium (n=3), and simple cuboidal epithelium (n=1). No patient developed complications or recurrences. Nasolabial cysts are relatively common in Singapore, and the diagnosis must be kept in mind if they are to be treated early. Diagnosis is based on clinical features and the treatment of choice is complete excision.

Scanning electron microscopic study of the nasolabial cyst: its clinical and embryological implications

OBJECTIVE

Nasolabial cyst is an uncommon midfacial cyst. It is considered to be a developmental anomaly arising from the rest of nasal respiratory epithelium. Although the cyst is a well-recognized entity, there remains some confusion of its origin, cell types, and ultrastructures. Based on the routine light microscopic study, some authors reported the epithelial cells of the inner lining of the nasolabial cyst were ciliated; some others reported they were nonciliated. To clarify this, a scanning electron microscopic study is needed.

STUDY DESIGN

This was a prospective clinical series.

METHODS

A transnasal marsupialization method was used to treat 10 patients with nasolabial cyst. With patients under local anesthesia, the roof of the cyst wall and a disk of nearby nasal mucosa were excised together with a sickle knife and scissors. Surgical specimens were dissected and processed for scanning electron microscopy and histochemistry. Patients were followed up for 8 to 65 months.

RESULTS

Marsupialization of cysts was successfully performed on all patients. Electron microscopically, the inner surface of the nasolabial cysts in all the cases was lined with nonciliated columnar epithelium consisting chiefly of goblet cells and basal cells. It is suggested that goblet cells contributed to clear, thin, and yellow mucus present in the cyst lumen. Instead of cilia, these epithelial cell surfaces were equipped with numerous short, globular, or irregular microvilli. Apical cytoplasm of adjacent cells did not tightly adhere to each other. Instead, microsulci of 1 to 3 microm in width formed between cells. Cytoplasmic processes from the lateral border spanned the microsulcus and contacted with those from neighboring cells.

CONCLUSION

The novel study has proved that the lining epithelium on the inner surface of the nasolabial cyst is columnar epithelium that chiefly consisted of two types of cells: goblet cells and basal cells. Not present were ciliated cells that were essential in the other portion of the respiratory tract. Numerous microvilli, instead of cilia, covered the inner lining of the nasolabial cyst, probably as a result of lacking the stimulation of air in ventilation as that on the other portion of the respiratory tract. The cilia of the epithelium were ill developed.

Nasoalveolar cysts: review of 3 cases

Nasoalveolar cysts, also known as nasolabial cysts or Klestadt's cysts, are rare, nonodontogenic, soft-tissue lesions that arise during development of the maxilla. They occur lateral to the midline in the region of the maxillary lip and alar base. In this case report clinical features and treatment options of three patients with nasoalveolar cysts are discussed.

Nasolabial Cyst: A Retrospective Analysis of 18 Cases

Nasolabial cysts are rare but easily identifiable when they do occur. They are thought to arise from the remnants of the nasolacrimal ducts, but most of the available information on these cysts is limited to isolated case reports. The purpose of our study was to examine the clinical and pathologic features of nasolabial cysts in order to provide a basis for their correct diagnosis and treatment. Eighteen patients with nasolabial cysts were treated at Korea University's Guro Hospital between Jan. 1, 1988, and Dec. 31, 1999. We retrospectively analyzed the clinical appearance, pathologic findings, and treatment results in each case. All patients underwent surgery via the sublabial approach. The lining epithelia were identified as either pseudostratified, stratified squamous, or simple cuboidal. A cyst recurred in only one case, and there were no surgical complications on follow-up. The results of our study provide a basis for sound diagnosis and treatment.