Nasopalatine duct cyst as a complication of dental implant placement: a case report

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Minimally invasive surgical approach in a large mandibular solitary cyst: case report and review of the literature

Solitary bone cyst (SBC) is an intraosseus radiolucent lesions that defers from real cysts for the fact that peripheral epithelial lining is totally absent. It could be classified as a psudocyst and occurs most frequently in young patients. In most cases SBC doesn't cause symptoms and it is often diagnosed accidentally during routine radiographic examination. A right diagnosis of this disease is also complicated because there are no pathognomonic radiographic signs and symptoms: so this form of pseudocyst is often misdiagnosed as a common odontogenic cyst. Despite numerous studies, the pathogenesis of the SBC is not yet established: the most widely accepted theory is that it could be the result of an intramedullary necrosis determined by a trauma. In this article we report a case of SBC in child treated with a minimal surgical approach. This new kind of treatment is much more conservative than the traditional one, it can be performed as outpatients, under local anesthesia and with few postoperative discomfort: For these reasons this minimal invasive technique appears to be particulary suitable for pediatric patients.

Nasolabial cyst: 18.5 year experience in a pathology laboratory

AIM

This paper offers a survey of nasolabial cysts diagnosed at the Pathology Laboratory of the Universidade Federal dos Vales do Jequitinhonha e Mucuri (Brazil) over a period of 18.5 years, and a case report.

METHODS

A retrospective study was carried out on biopsies performed at the Pathology Laboratory of the UFVJM School of Dentistry between January 1992 and July 2010.

RESULTS

Among a total of 2730 histopathological exams of biopsies performed at the UFVJM Pathology Laboratory, 288 (10.54%) were different types of cysts, The prevalence of NLC was 0.29% (8 cases) in relation to the overall sample and 2.43% among all cysts. NLC only occurred in the female gender in the age group spanning from 25 to 62 years (mean: 40.00 years; standard deviation (SD): 13.48 years). The duration of evolution ranged from six to 18 months (mean: 12 months; SD: 3.79 months). The cysts were asymptomatic in 62.5% of cases. Cyst size ranged from 10 to 30 mm (mean: 16.86; SD: 8.00 mm). In six cases (75%), the radiographic exams were consistent with the final diagnosis, whereas there were no records of radiographic images in two cases (25%). Surgical excision was the treatment of choice for all cases.

CONCLUSION

The characteristics of NLC, such as location, elevation of the nasal wing, disappearance of the nasolabial sulcus, nasal obstruction, floatation of the cyst and the presence of cystic liquid in the interior, are enough to suggest the diagnosis of this cyst. However, the confirmation of the diagnosis is performed through biopsy and histopathological analysis.

A case of anterior maxillary radiolucency

A 46-year-old woman sought treatment for pain in her maxillary anterior teeth. Physical examination revealed facial tenderness and an expanded anterior maxilla, with palatal swelling in the approximate midline. The lesion had eroded through the midline anterior palate and anterior nasal spine and had shifted the nasal floor in a superior direction. Teeth No. 8-10 tested nonvital to electrical stimulation. The lesion was dissected carefully and lifted off the nasal floor while the patient was under general anesthesia. Histologically, the lesion was cystic with an epithelial lining composed of respiratory and squamous epithelium. As a result, a nasopalatine duct cyst was diagnosed.

Oral and maxillofacial pathology in three dimensions

It is clear that the dental profession has entered a new age of radiographic diagnostic imaging. A number of examples have shown that being able to visualize oral and maxillofacial pathologic entities in three dimensions assists in diagnosing and planning the appropriate treatment. The technology is an improvement for our profession and for the patients it serves.

Nasolabial cyst with radiographic contrast medium: report of two cases

Two cases are presented of a nasolabial cyst (NC) on which a radiographic contrast medium was used in order to define the real extension of the lesion. Use of contrast is important for visualizing the definite extensions of NC primarily in cases when plain radiographs may not show any detectable changes and CT can not be used.

[Rare case of the large-sized, unilateral incisive canal cyst]

A rare case of an extremely large, unilateral incisive canal cyst (nasopalatine duct cyst), located between the teeth #11 and #25 is presented. The upper border of the cyst extended to the nasal cavity, the posterior border was the maxillary sinus while the lower border was 5 mm above the maxillary alveolar process. The apices of the vital teeth 21, 22, 23 were in the cyst. Cystectomy was combined with the implantation of an osteoconductive bone substitute material (beta-tricalcium-phosphate). The origin of the cyst was verified by histological examination. The authors also review the origin and pathology as well as the clinical and radiological symptoms and therapy of the non-odontogenic cysts.

Diagnosis and Surgical Management of Nasopalatine Duct Cysts

OBJECTIVES/HYPOTHESIS

Nasopalatine duct cysts are the most common cystic lesion of nonodontogenic origin of the maxilla. The purposes of the study were to review the epidemiology and clinical presentation, to describe the radiographic and pathological findings, and to discuss surgical management of this entity.

STUDY DESIGN

Case presentations of two patients with nasopalatine duct cysts at a tertiary care institution with a review of the English medical literature from January 1960 to the present.

METHODS

A 69-year-old man presented with an asymptomatic swelling of the premaxilla, and a 17-year-old woman presented with a painful swelling of the hard palate. A computed tomography scan, fine-needle aspiration, and preoperative workup were obtained in both cases. Literature was reviewed with respect to epidemiology, etiology, presentation, diagnostic studies, operative management, and recurrence rates.

RESULTS

Computed tomography scan demonstrated midline ovoid cystic lesions in both cases. Fine-needle aspiration of both lesions revealed no evidence of malignancy. Surgical treatment consisted of enucleation in the first case and marsupialization in the second case. Both patients did well with no evidence of recurrence. Nasopalatine duct cyst presents in the fourth to sixth decades of life with a male predilection. Recurrence rates range from 0% to 11%.

CONCLUSION

Nasopalatine duct cyst occurs in approximately 1% of the population. Presentation may be asymptomatic or include swelling, pain, and drainage from the hard palate. A well-circumscribed, round, ovoid, or heart-shaped radiolucency is seen on computed tomography. Pathological findings reveal squamous or respiratory cell types, or a combination of these, infiltrated by inflammatory cells. Enucleation is the preferred treatment with low recurrence rates.

[Nasopalatine canal cyst: 4 cases and a review of the literature]

OBJECTIVES

Nasopalatine cyst (NPC) is the most common epithelial and non-odontogenic cyst arising in the maxilla. It is nevertheless generally underestimated by ENT surgeons. The purpose of our report was to provide details about the pathophysiology, diagnosis and treatment of NPC.

MATERIAL AND METHODS

Our study was based on a retrospective analysis of four cases and a review of the literature.

RESULTS

From January 2002 to March 2003, four patients (3 males and 1 female, mean age 43 Years) were treated for NPC at the ENT Department of Grenoble University hospital. One patient had received prior treatment. Symptoms were a palatine mass on the midline of the hard palate behind the central maxillary incisors in two patients, and a superior vestibular mass in the two others. Diagnosis was established on the basis of the CT-scan and histological findings. Excision was performed under general anesthesia in all four patients. Median hospital stay was four days (3-5 days). There was no post-operative complication. Median follow-up was 10 Months.

CONCLUSION

NPC is arises from embryological tIssue. It must be differentiated from radicular cyst. Diagnosis is based on radiographic and histological results. Treatment consists in enucleation. Surgical access depends on the size of the cyst and its anterior or posterior extension. Excision must be total to avoid relapse which may occur after five Years. Long-term follow-up is essential.

[Nasolabial cyst: two cases]

Nasolabial cysts are developmental swellings originating from the epithelial remnants of the nasolacrimal ductus. In this report we present two female patients (age 44 and 54 years) with nasolabial cysts. In both cases the leading complaints arose from cosmetic appearance. Surgical excision by sublabial approach was performed. Histopathological diagnoses were in agreement with the clinical diagnoses. The patients had an uneventful postoperative period and no recurrences were seen during a follow-up period of 12 months.

MR imaging of nasopalatine duct cysts

We describe the magnetic resonance (MR) features of two cases of nasopalatine duct cyst (NPDC), including the first presentation of T1-weighted images (WI). The signal intensity of the cases of NPDC showed homogeneous high signal intensity on both on T1 and T2WI, although most cysts of maxillofacial regions demonstrate low to intermediate signal intensity on T1WI. NPDC may commonly be of high signal intensity on T1WI, which is consistent with keratin and viscous fluids.

CT analysis of a complicated nasopalatine duct cyst

A study was conducted to evaluate CT imaging in differentiating nonodontogenic nasopalatine duct cysts from odontogenic radicular cysts. The patient's palatine cystic lesion was analyzed by CT and excised with postoperative microscopic identification. CT findings of a nasopalatine cyst are midline location, smooth expansion with sclerotic margins and displacement of teeth apices. Radicular cysts differ in that the teeth apices are within the cyst rather than being displaced. We concluded that differentiation is clearly demonstrated by CT images.

A new transnasal approach to endoscopic marsupialization of the nasolabial cyst

OBJECTIVE

Nasolabial cyst is a mucus-secreting, nonodontogenic cyst in the nasofacial area. It is usually situated behind the ala nasi, extending backward beneath the nasal floor into the inferior meatus and forward into the labio-gingival sulcus behind the upper lip. Patients with nasolabial cysts generally undergo surgical removal of the cyst via a transoral sublabial approach. This article reports a simple, less invasive surgical procedure for the treatment of nasolabial cysts.

STUDY DESIGN

A transnasal endoscopic marsupialization method was designed to treat patients with nasolabial cysts. From 1996 through 1998, 16 consecutive patients underwent this new surgical procedure.

METHODS

With patients under local anesthesia, the roof of the cyst, which was firmly attached to the mucous membrane of the anterior nasal floor, was removed transnasally with a sickle knife and scissors. Under the guidance of a nasoendoscope, the opening of the cyst was widened with bite forceps. Meanwhile, the cut edges of the nasal mucosa and the epithelium lining of the cyst were adequately matched. The nose was then loosely packed.

RESULTS

All but 1 of the 15 patients were successfully treated with this technique, and the whole surgical procedure was usually completed within 15 to 20 minutes. Postoperative endoscopic and radiological findings revealed that the cyst was replaced by an air-containing sinus with a persistent opening at the anterior or anterolateral nasal floor. There has been no evidence of mucus accumulation in the newly created sinus or recurrence of the cyst during a mean follow-up of 16 months.

CONCLUSIONS

Transnasal endoscopic marsupialization is a simple and effective surgical procedure for treatment of nasolabial cysts.

[Post-traumatic facial deformity. Globulomaxillary cyst]

The case of a child treated for globulomaxillary cyst is presented. He first consulted because of progressive deformity of the face and upper gum, starting several months before. He had a history of facial contusion at the time the deformity began.

A lesion of endodontic origin misdiagnosed as a globulomaxillary cyst

This report presents a case of a lesion originating from a pulpless central incisor misdiagnosed as a globulomaxillary cyst. The initial diagnosis of globulomaxillary cyst was made solely from radiographs by observing an almond-shaped radiolucency between the lateral incisor and cuspid. No pulp testing was performed before surgical removal of the lesion. The final diagnosis of an endodontic lesion caused solely by a pulpless central incisor was complicated by the initial lack of a pulpal response from the lateral incisor next to the surgical site. By delaying the start of endodontic treatment, pulp sensibility returned to the lateral incisor and the diagnosis of an endodontic lesion caused only by a pulpless central incisor was confirmed.

Application of cross-sectional imaging in the differential diagnosis of apical radiolucency

A case is described in which exact localization of a cystic lesion associated with the apices of the maxillary central incisor teeth was sought to aid diagnosis and presurgical planning. The area was imaged using cross-sectional tomographic slices in the sagittal plane produced by a Scanora multimodal tomographic unit (Orion Corporation Soredex, Helsinki, Finland). The images demonstrated the cystic lesion arising within the incisive canal, conforming a diagnosis of naso-palatine duct cyst. Surgery was therefore performed via a palatal approach giving direct access to the cyst. Histological examination of the enucleated cyst confirmed a nasopalatine duct cyst.

Virtual image guided navigation in tumor surgery--technical innovation

We present a new visualization system for image-guided stereotactic navigation in tumor surgery. The combination of frameless stereotactic localization technology with real-time video processing permits the visualization of medical imaging data as a video overlay during the actual surgical procedure. Virtual computer-generated anatomical structures are displayed intraoperatively in a semi-immersive head-up display. This results in surgical navigation assistance without limiting the judgement of the physician based on the continuous observation of the operating field. The case presented documents the potential of augmented reality visualization concepts in tumor surgery of the head.

Radiographic maxillary sinus findings in the elderly

The prevalence of radiographic maxillary sinus findings in 293 elderly subjects (76, 81, and 86 years old) were investigated with the use of panoramic radiography: 124 subjects were edentulous in both jaws, 167 had an edentulous maxilla, and 169 had at least one natural tooth left. Mucous cysts or diffuse mucosal thickenings were found in 12% of the subjects. Of the mucosal thickenings, 70% were found in subjects with a dentate upper jaw (p < 0.05), suggesting an odontogenic origin for that proportion (40%) exceeding the prevalence in subjects edentulous in the maxilla. That the prevalence of mucous cysts was 5% both in subjects with a dentate upper jaw and in those with a edentulous upper jaw suggests nonodontogenic causes.

Healing of globulomaxillary cyst after non-surgical endodontic treatment--"case report"

A case of 23-years-old male patient who was referred from an oral surgeon for endodontic treatment of his maxillary left central, Lateral incisors and canine. The patient had a pear-shaped radiolucent lesion between the roots of the lateral incisor and canine, with the widest part of the lesion encroaching over the apices of the involved teeth. All of the three teeth with intact crowns and no history of trauma, and having a healthy vital pulps. Root canal treatment was carried out, one day before the scheduled surgical enucleation appointment-in one visit. The patient did not undergo the surgery. One year later, a radiograph revealed complete osseous repair of the lesion.

Case report: bilateral nasoalveolar cysts

Nasoalveolar cysts are rare developmental cysts arising in the region of the upper lip, just below the ala nasi. We present a case where a woman was suspected of having a local abscess. The microscopic features of this abscess were consistent with nasoalveolar cysts.

[Radiographic findings of the so-called globulomaxillary cyst]

In definite diagnosis of this cyst, it is deemed that a comprehensive diagnosis is required including operative findings upon its extraction and the pathohistological findings of the extracted matter in addition to the radiographic and clinical findings, such as one that the region of development is between the maxillary lateral incisor and the cuspid, one that the adjacent teeth are vital ones, etc. Thus, we examined 10 cases that we had defined as the subjects of so-called Globulomaxillary cyst by clinical and pathohistological findings in terms of the developmental region, size, border, etc. As a result, the following things turned out: 1. The median positions of cystic development existed 8 cases in left side and 2 cases in right side out of 10 cases. And this median positions could be divided into those between the central incisor and the lateral incisor (5 cases) and those between the lateral incisor and the cuspid (5 cases). 2. The pathohistological findings led to the following classification; 2 cases with no inflammation, 5 cases with inflammation, and 3 cases with present inflammation in the past. The border line of cyst on radiographic findings tended to be relatively unclear in the cases with inflammation in the past.

Cysts of the nasopalatine duct

Nasopalatine duct cysts in 70 patients were reexamined clinically and radiographically. 50 of them were also reexamined histopathologically. 20 specimens of normal duct tissue were likewise examined. More than half of the cysts showed clinical symptoms. The form on the radiograph was usually spherical or oval. Only 1 of 5 cysts was heart-shaped; 1 of 10 was unilateral. The mesiodistal width of the cysts ranged from 4-40 mm, with 75% from 6-12 mm. 3 of 4 showed pronounced radiolucency. Every 2nd cyst was completely surrounded by a thin radiopaque border. The histopathological investigation showed small cysts to be present in 1 of 4 clinically and radiographically normal nasopalatine ducts. More than 1 of 4 clinically and radiographically diagnosed cysts lacked histopathological characteristics of a cystic cavity. The type of epithelium in the cysts was independent of the vertical position in the duct.

Nasopalatine duct cyst

A retrospective and follow-up study of 35 cases of nasopalatine cysts was performed. The retrospective part of the investigation comprised clinical, radiological and histological observations including pre-, intra- and post-operative findings. The follow-up included clinical and radiological observations. The results indicated that most cysts are found during routine clinical and radiological examination. Subjective and objective clinical symptoms were reported in 50% and 59% of the cases, respectively, the most common being swelling and pain. It was not possible to confirm any specific etiological factor. In 97% of the cases, maximum cyst diameter varied between 1.0-2.5 cm and 84% appeared round or ovoid. Histological examination revealed a high frequency of cuboidal and/or columnar epithelial lining, 2-3 cell layers thick, in combination with an adjacent zone of hyalinized capsular tissue with low-grade inflammation. Radiologically these cases exhibited a well-defined cortical border. In the follow-up study, 84% of the patients exhibited complete clinical healing with no objective or subjective symptoms. Complete bone regeneration was seen radiologically within 3 years in 82% of the cases examined. The results of the present study were compared to those obtained in previous reports.

Huge growth potential of the nasolabial cyst

Two cases of nasolabial cyst are reported. The first case demonstrates the typical features of this rare soft-tissue developmental cyst. In the second case a huge cyst caused severe facial deformity. This case demonstrates the huge growth potential of the nasolabial cyst.

Nasopalatine duct cyst

The nasopalatine duct cyst appears to be an aggressive and symptomatic condition in the South African black population group. Of a total of 114 cases, 30 patients, all blacks, had cysts in excess of 30 mm in diameter. Two patients with large nasopalatine duct cysts, one of which was infected, underwent computed tomography. Computed tomography is an excellent method of demonstrating the extent, bony destruction and relationship of the lesion to neighbouring structures. A review of the subject with clinical and radiological features is presented.

Well-defined radiolucent area involving the anterior maxilla

An example of a large and symptomatic nasopalatine duct cyst is presented. This cyst is the most common type of developmental or fissural cyst occurring in the maxilla. Treatment for most patients is conservative surgical excision. The excised tissue should be submitted for histopathologic examination to establish a definitive diagnosis and to rule out the possibility of a more serious lesion.

Contribution of radiographs to the diagnosis of naso-alveolar cyst

Eight cases of nasoalveolar cyst are reported; seven of these cases demonstrated radiographically identifiable changes. The literature is reviewed, and clinical and cytologic characteristics of the lesions are discussed. The importance of radiographs in the diagnosis of nasoalveolar cysts is emphasized.

[Roentgenologic differential diagnosis of jaw cysts]

Using routine X-ray pictures the different types of jaw cysts are presented and the characteristic findings of the individual cyst types are emphasised. An exact diagnosis can often be made using only the panorama tomograph, particularly if the topographic position of the cyst and any relationship to the dental system are taken into account. The differential diagnosis becomes difficult in cases where the peripheral compact lamella is missing or the bony border is not sharp, and in cases of honeycombed, multilocular, polycystic form. In such cases tumours, metastases and systemic diseases must be included in the differential diagnosis of various jaw cysts.

Unusually large nasopalatine cyst: CT findings

In a patient presenting with nasal obstruction the clinical suspicion of a nasal mass led to computed tomography that demonstrated findings thought to be characteristic of an unusually large nasopalatine cyst. The definitive diagnosis of nasopalatine cyst is more easily made on plain films. The entity is described, emphasizing once again the necessity of including dental and facial abnormalities in the differential diagnosis of lesions of the sinuses and nose.

Postoperative maxillary cyst

The postoperative maxillary cyst develops in the maxillary sinus between the ages of 30 and 40 in persons who received sinus surgery 10 to 20 years earlier. Etiology of the cystic lesion appears to be derived from the infected sinus mucosa left after a sinus operation. Chief complaints of postoperative maxillary cysts are swelling or pain in the buccal region, discomfort of the maxilla or maxillary teeth and exophthalmos. Characteristic panoramic radiographic findings of the postoperative maxillary cyst are a monolocular cystic radiolucency with a well-defined margin and surrounding sclerotic bone in the floor of the maxillary sinus.

Pathological conditions involving the maxillary sinus: their appearance on panoramic dental radiographs

Panoramic dental radiography does not replace conventional techniques for viewing the maxillary sinuses but is a useful adjunct. Unsuspected antral diseases, from innocuous mucosal cysts to insidious squamous carcinoma, may be detected during routine use of this procedure.