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Table of Contents   
CASE REPORT  
Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 225-227
A rare case of bilateral nasolabial cysts in a postpartum lady


Department of ENT, Christian Medical College, Vellore, Tamilnadu, India

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Date of Submission01-Mar-2013
Date of Decision02-Apr-2013
Date of Acceptance05-May-2014
Date of Web Publication4-Jul-2014
 

   Abstract 

Nasolabial cyst, also known as Klestadt's cyst is an uncommon nonodontogenic cyst. Bilateral nasolabial cysts are rarer and less than 10 cases have been reported in the literature. Diagnosis is usually clinical and they present as slow-growing swellings in the nasolabial region causing cosmetic deformity and nasal obstruction. A postpartum lady presented with bilateral swelling of the cheeks. Excision was done via a sublabial approach. She is asymptomatic one year after surgery. Nasolabial cysts are developmental but usually noticed after a trauma. There is no data relating the cysts to pregnancy.

Keywords: Bilateral, cyst, nasal cavity, postpartum

How to cite this article:
Chandrasekharan R, Varghese AM, Mathew J, Ashish G. A rare case of bilateral nasolabial cysts in a postpartum lady. Indian J Dent Res 2014;25:225-7

How to cite this URL:
Chandrasekharan R, Varghese AM, Mathew J, Ashish G. A rare case of bilateral nasolabial cysts in a postpartum lady. Indian J Dent Res [serial online] 2014 [cited 2020 Jan 21];25:225-7. Available from: http://www.ijdr.in/text.asp?2014/25/2/225/135929
Cysts in the head and neck are common in the soft tissues of the orofacial region and within the jaws. They may be inflammatory or developmental. [1] Nasolabial cysts are developmental nonodontogenic masses that arise in the maxillofacial soft tissue. [2]

Diagnosis is usually clinical and they present as slow-growing masses in the nasolabial region and are asymptomatic. The patient usually presents with cosmetic deformity or nasal obstruction. [3]

Bilateral lesions are rare, account for 10-11.2% of all nasolabial cysts, and are more common in black people. [3] A search of Pubmed literature revealed only eight published cases of bilateral cysts. [2],[4],[5] We report the first case of bilateral nasolabial cysts in India.


   Case report Top


A 33-year-old lady presented with a swelling over the right cheek of a duration of three months which was initially small but increased progressively in size. She felt the swelling started after her small baby kicked her on the face. She also complained of bilateral nasal blockage (right > left) for one month. There was no history of any nasal discharge or loose tooth. She was not a diabetic or hypertensive. She was 11 months postpartum on presentation.

On examination, there was an ill-defined swelling over the right cheek obliterating the right nasolabial fold. Anterior rhinoscopy revealed a nontender mucosa-covered cystic swelling in the floor of the right nasal cavity. On the left floor of the nose, there was another small swelling. There was no paranasal sinus tenderness. Examination of the ear and throat was normal.

CT scan of the nose and paranasal sinuses [Figure 1] showed a 2.2 × 2.3 × 2.1 cm soft tissue density lesion in the subcutaneous plane in the right maxillary region and a 1 × 0.9 cm similar lesion on the left side. The underlying bones were normal.
Figure 1: Preoperative computed tomography scan showing bilateral cysts

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Ultrasonography showed it to be thick-walled cystic lesions with internal septations and low-level internal echoes.

Under general anesthesia with endotracheal intubation, excision of bilateral nasolabial cysts was done with a sublabial approach. On the right side, the finding was of a 4 × 4 cm cyst filled with straw-colored fluid and on the left side, there was a 2 × 2 cm cyst also filled with straw-colored fluid. The cysts were excised in toto.

Histopathological examination [Figure 2] showed a cyst partly lined by pseudostratified columnar epithelium and partly by stratified squamous epithelium. The wall of the cyst contained a few mucous glands, hemorrhage, fibrinous material and inflammatory infiltrates of lymphocytes, plasma cells and eosinophils. There were no granulomas or any evidence of malignancy.
Figure 2: Histopathological picture

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One year after the surgery, the patient is asymptomatic. A repeat computed tomography (CT) scan was normal [Figure 3].
Figure 3: Computed tomography scan one year post operation showing no recurrence/residual lesion

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   Discussion Top


Nasolabial cysts were first described by Zuckerkandl in 1882. [3] They represent about 0.7% of all cysts in the maxillofacial region and 2.5% of nonodontogenic cysts. [1] They are more common in women and arise mainly in the fourth and fifth decades of life. [3]

Over the years, nasolabial cysts have been given many synonyms like nasoalveolar cysts, nasal vestibular cysts, nasal wing cysts, Klestadt's cysts, and mucoid cysts of the nose. The pathogenesis of nasolabial cysts is controversial. Brown Kelly in 1898 thought them to be retention cysts arising from inflamed mucous glands. Another theory is that they are of fissural origin, derived from developmental rests along the site of fusion of the maxillary and medial nasal and lateral nasal processes. [2] Brüggemann in 1920 proposed that nasolabial cysts develop from the remnants of the embryonic nasolacrimal ducts. This was supported by the fact that the nasolacrimal ducts like the nasolabial cyst cavity are lined by pseudostratified columnar epithelium. [3]

Nasolabial cysts appear as spherical masses embedded beneath the soft tissue of the nasal ala. They may extend anteriorly in the pyriform aperture, inferiorly into the gingivolabial sulcus, or laterally into the facial soft tissue. [2]

The differential diagnoses include odontogenic, developmental, and neoplastic lesions. The odontogenic ectodermal cysts that should be excluded are: (1) Follicular cysts: (a) Primordial (b) dentigerous: Central and lateral. (2) Periodontal cysts: Apical and lateral. (3) Residual cysts. [5]

Vitality test helps in differentiating nasolabial cysts from periapical pathologies like granuloma, abscess, or cyst. [1] Odontogenic cysts are usually intraosseous, and the extraosseous locations of nasolabial cysts should render the differential diagnosis straightforward.

CT scan is a useful tool for diagnosis and determination of the surgical approach. [6] The nasolabial cyst is seen as a homogeneous nonenhancing cystic mass anterior to the pyriform aperture, with no erosion or separation of the underlying maxilla. There may be a depression in the anterior maxillary bone due to the pressure effect from the chronic nature of the lesion. [7] Magnetic resonance imaging (MRI) scan of nasolabial cysts shows relative hyperintensity in T1-weighted images and isointensity in T2-weighted images. [8]

Although injection of sclerosing agents has been described, surgical excision is the treatment of choice. Excision may be open via a sublabial approach or can be done endoscopically. [1],[9]

The sublabial approach is the most popular and well-established procedure for the management of nasolabial cysts with a wider surgical field and more assurance of a complete excision. [10] Complications include postoperative bleeding, hematoma, soft tissue swelling of the face, and wound infection. [7],[10]

Su et al. described the transnasal endoscopic marsupialization of nasolabial cysts. They described it as less invasive with minimal blood loss which can be performed under local anesthesia and as an outpatient procedure. [10] Under endoscopic guidance, an incision is made along the roof of the cyst wall and the nasal mucosa above it is excised. Postoperatively, these patients have an air-containing sinus with a patent opening in the premaxillary area. [7] Microdebriders can also be used to open and trim the roof of the cyst. [9] Complications of this procedure include accumulation of mucus in the pocket, stenosis of the opening, and recurrence of the cyst.

The endoscopic technique is easier to perform on larger rather than smaller cysts because it is easier to create a wide opening in larger cysts. [10] Open/sublabial excision may be a better choice in patients with smaller lesions. [7] Chao et al. compared the two approaches and found that both operations were successful and no major complications were there in either. [7]

The association of nasolabial cyst with trauma is not reported but most of the time, as in our case, the patient notices the lesion after a trauma. The question as to why these cysts present in the fourth and fifth decades although they are described as of developmental origin is also unanswered in the literature. The fact that they are commonly seen in women in the perimenopausal age points toward the involvement of some hormonal receptors. There is insufficient data to relate nasolabial cysts with pregnancy.

 
   References Top

1.Patil K, Mahima VG, Divya A. Klestadt's cyst A rarity. Indian J Dent Res 2007;18:23-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Kyrmizakis DE, Lachanas VA, Benakis AA, Velegrakis GA, Aslanides IM. Bilateral nasolabial cysts associated with recurrent dacryocystitis. J Laryngol Otol 2005;119:412-4.  Back to cited text no. 2
    
3.Aquilino RN, Bazzo VJ, Faria RJ, Eid NL, Bóscolo FN. Nasolabial cyst: Presentation of a clinical case with CT and MR images. Braz J Otorhinolaryngol 2008;74:467-71.  Back to cited text no. 3
    
4.Marcoviceanu MP, Metzger MC, Deppe H, Freudenberg N, Kassem A, Pautke C, et al. Report of rare bilateral nasolabial cysts. J Craniomaxillofac Surg 2009;37:83-6.  Back to cited text no. 4
    
5.El-Din K, el-Hamd AA. Nasolabial cyst: A report of eight cases and a review of the literature J Laryngol Otol 1999;113:747-9.  Back to cited text no. 5
    
6.Kato H, Kanematsu M, Kusunoki Y, Shibata T, Murakami H, Mizuta K, et al. Nasoalveolar cyst: Imaging findings in three cases. Clin Imaging 2007;31:206-9.  Back to cited text no. 6
    
7.Chao WC, Huang CC, Chang PH, Chen YL, Chen CW, Lee TJ. Management of Nasolabial Cysts by Transnasal Endoscopic Marsupialization. Arch Otolaryngol Head Neck Surg 2009;135:932-5.  Back to cited text no. 7
    
8.Cure JK, Osguthorpe JD, Van Tassel P. MR of nasolabial cysts. Am J Neuroradiol 1996;17:585-8.  Back to cited text no. 8
    
9.Chen CN, Su CY, Lin HS, Hwang CF. Microdebrider-assisted endoscopic marsupialization for the nasolabial cyst: Comparisons between sublabial and transnasal approaches Am J Rhinol Allergy 2009;23:232-6.  Back to cited text no. 9
    
10.Su CY, Chien CY, Hwang CF. A New Transnasal Approach to Endoscopic Marsupialization of the Nasolabial Cyst. Laryngoscope 1999;109:1116-8.  Back to cited text no. 10
    

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Correspondence Address:
Ramanathan Chandrasekharan
Department of ENT, Christian Medical College, Vellore, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.135929

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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