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A nasoalveolar cyst without an epithelial lining
Section
of the
Federal dental services
A nasoalveolar cyst without an epit helial lining Report
of Q case
Sheldon M. Jfintz, B.S., D.D.S.,” New York, N. Y.
N
asoalveolar cysts are relatively uncommon. These are fissural cysts formed from epithelial cell rests entrapped at the junction of the globular, lateral nasal, and maxillary processes.” ~3 The clinical features of these cysts have been listed as follows: 1. They are usually seen in Negroes. 2. Regional teeth are vital. 3. The cysts are located at the base of the nostril. 4. They produce a. swelling in the base of the upper lip noticeable in the vcstihule of t)he oral cavit,y as well as in the adjacent nasal floor. 5. The swelling, which is ftuct,uant, may become so large that the patient, presents a decided asymmetry of the nose and face.‘, -’ Roentgenographic findings are usually not significant.. If, however, the cyst resorbs the bone from the periosteal side by pressure, the rornt,genograms ma! show radiolucency.4 The histopathologic features reported by various authors include a drscripCon of cyst epibhelium as one of either stratified squanlous or respiratory epithelium containing goblet cells.L z94 In the remaining histopathologic feat,urcs, these lesions closely resemble odontogenic cysts. The following caseis of interest in that, clinically as well as roentgenographitally, it satisfied all of the aforementioned criteria. In this particular cast, however, the usual microscopic cpithclial features were absent.
128
Volume Number
20 1
Fig.
CASE
1. Preoperative
photograph
taken
on May
4, 1964.
REPORT
A &l-year-old Negro woman was referred to the Oral Surgery I)epartmc%t of the Fort Jay Army Dental Clinic with a swelling in the region of the anterior left maxillary vestibule. There was a slight distortion of the left ala of the nose. The swelling was asymptomatic. 2 weeks prior to her initiaI examination on Xay 4, The patient first nobieed this swelling 1964. The lesion was asymptomatic, but the patient stated that she had been unable to wear her maxillary partial denture since the swelling occurred. Clinical examination disclosed a fluctuant swelling of the left anterior maxillary vestibule, measuring approximately 2 by 2 cm. and extending from the superior labial frenum to the apex of the left maxillary lateral incisor. The mucosa was not inflamed. The upper left lip and ala of the nose were slightly distorted. Clinically, no elevation of the adjacent nasal floor was seen when the anterior nares were examined. The maxillary central incisors mere missing. The left lateral incisor and cuspid were vital and revealed no pathologic states. Roentgenographic examination revealed an increased radiolucency in the area of the missing left maxillary central incisor which extended over the area of the adjacent lateral incisor. The radiolueency had no definite delineation indicative of central ostcolysis. There was no evidence of peripheral reactive lamellar formation around the radiolucency. In vic,w of the diagnostic findings, it teas decided t.hat this lesion eats a nasoalvroIar cyst. Surgical
procedure
On May 6, 1964, local anesthesia was eRected with 2 per cent lidoeainr blocks of the and a 45 degree angulated incision \vas made in the anterior superior alveolar nerves, mueolabial fold distal to the left lateral incisor. It was carried around the neck of this tooth, along the crest of the edentulous ridge, and then upward at a 45 degree angle into the mucolabial fold distal to the right lateral incisor. The nmcosa was dissected bark with a attached to the maxilla inferior to the ala blunt reflector. A yellowish ovoid cyst sac, firmly of the noc(‘, became visible. The cyst was detached intact from the maxilla and from tlic, nasal floor to which it was adherent. The nasal mucosa was not perforated and apI~parc~1 free of residual cyst tissue, but erosion of the bout dip in the cyst carity was cl-itlttttt. Th(, tissuta flap was rcapproximated and closed lrith multiple 3-O silk intorruptcrl suturctr. The specimen, roentgrnograms, and cliniral photographs wc~e forzvard(d to the Department of Dental and Oral Pathology, ITnitcd States Army Inst,itute of IIcutal HcwRI.~~~~, ITalter Reed Army Plledieal Center.
130
4
ill ill tz
O.S..O.,\l. I\ 0.1'. .I ul,v, I!lli.,
131
VOlUllE
Number
Pi{, '. 4. 1?l~oton~icrogmpl~
. 7. Closure
of incision
of cyst.
following
Note
lack
removal
of epithelial
of cyst
lining.
on May
6, 1964.
Postoperative
course
SUMMARY
The foregoing case manifests the classic diagnostic features of nasoalvcolar cyst, except for t,he fact that. no epithelial layer was present. This absence 01’ epithclium is unique, but it is apparent that a correct diagnosis of r~asoalvrolar cysts is contingent upon a combination of clinical, roentRcno~raghic, and microscopic studies. REFERENCES
1. Thoma, K. II., and Goldmnn, H. JI. : Oral Pathologv, rd. .i, Pt. Mosby Company, pp. 820-821. H. (+.: Color Atlas of 2. Colby, R. A., Kerr, D. A., a,nd Robinson, Philadelphia, 1961! J. B. Lippincott Company, p. 29. A Textbook of 3. Shafer, W. G., Hmr, M. K., and Levy, R. M.: Philadelphia, 1963, \V. 13. Hsundws Company, 1,. 69. 4. Bhaskar, R. N.: Synopsis of Oral Pathology, St. Louis, 1961, ‘1’hl~ p. 200.
Louis,
IHAO,
Oral
Pathologv,
cd.
L’,
Oral
Pathology,
~1.
2,
(‘. T’. MOSll~
1’11~ (:. Y.
~‘ompxny,
of the
Federal dental services
A nasoalveolar cyst without an epit helial lining Report
of Q case
Sheldon M. Jfintz, B.S., D.D.S.,” New York, N. Y.
N
asoalveolar cysts are relatively uncommon. These are fissural cysts formed from epithelial cell rests entrapped at the junction of the globular, lateral nasal, and maxillary processes.” ~3 The clinical features of these cysts have been listed as follows: 1. They are usually seen in Negroes. 2. Regional teeth are vital. 3. The cysts are located at the base of the nostril. 4. They produce a. swelling in the base of the upper lip noticeable in the vcstihule of t)he oral cavit,y as well as in the adjacent nasal floor. 5. The swelling, which is ftuct,uant, may become so large that the patient, presents a decided asymmetry of the nose and face.‘, -’ Roentgenographic findings are usually not significant.. If, however, the cyst resorbs the bone from the periosteal side by pressure, the rornt,genograms ma! show radiolucency.4 The histopathologic features reported by various authors include a drscripCon of cyst epibhelium as one of either stratified squanlous or respiratory epithelium containing goblet cells.L z94 In the remaining histopathologic feat,urcs, these lesions closely resemble odontogenic cysts. The following caseis of interest in that, clinically as well as roentgenographitally, it satisfied all of the aforementioned criteria. In this particular cast, however, the usual microscopic cpithclial features were absent.
128
Volume Number
20 1
Fig.
CASE
1. Preoperative
photograph
taken
on May
4, 1964.
REPORT
A &l-year-old Negro woman was referred to the Oral Surgery I)epartmc%t of the Fort Jay Army Dental Clinic with a swelling in the region of the anterior left maxillary vestibule. There was a slight distortion of the left ala of the nose. The swelling was asymptomatic. 2 weeks prior to her initiaI examination on Xay 4, The patient first nobieed this swelling 1964. The lesion was asymptomatic, but the patient stated that she had been unable to wear her maxillary partial denture since the swelling occurred. Clinical examination disclosed a fluctuant swelling of the left anterior maxillary vestibule, measuring approximately 2 by 2 cm. and extending from the superior labial frenum to the apex of the left maxillary lateral incisor. The mucosa was not inflamed. The upper left lip and ala of the nose were slightly distorted. Clinically, no elevation of the adjacent nasal floor was seen when the anterior nares were examined. The maxillary central incisors mere missing. The left lateral incisor and cuspid were vital and revealed no pathologic states. Roentgenographic examination revealed an increased radiolucency in the area of the missing left maxillary central incisor which extended over the area of the adjacent lateral incisor. The radiolueency had no definite delineation indicative of central ostcolysis. There was no evidence of peripheral reactive lamellar formation around the radiolucency. In vic,w of the diagnostic findings, it teas decided t.hat this lesion eats a nasoalvroIar cyst. Surgical
procedure
On May 6, 1964, local anesthesia was eRected with 2 per cent lidoeainr blocks of the and a 45 degree angulated incision \vas made in the anterior superior alveolar nerves, mueolabial fold distal to the left lateral incisor. It was carried around the neck of this tooth, along the crest of the edentulous ridge, and then upward at a 45 degree angle into the mucolabial fold distal to the right lateral incisor. The nmcosa was dissected bark with a attached to the maxilla inferior to the ala blunt reflector. A yellowish ovoid cyst sac, firmly of the noc(‘, became visible. The cyst was detached intact from the maxilla and from tlic, nasal floor to which it was adherent. The nasal mucosa was not perforated and apI~parc~1 free of residual cyst tissue, but erosion of the bout dip in the cyst carity was cl-itlttttt. Th(, tissuta flap was rcapproximated and closed lrith multiple 3-O silk intorruptcrl suturctr. The specimen, roentgrnograms, and cliniral photographs wc~e forzvard(d to the Department of Dental and Oral Pathology, ITnitcd States Army Inst,itute of IIcutal HcwRI.~~~~, ITalter Reed Army Plledieal Center.
130
4
ill ill tz
O.S..O.,\l. I\ 0.1'. .I ul,v, I!lli.,
131
VOlUllE
Number
Pi{, '. 4. 1?l~oton~icrogmpl~
. 7. Closure
of incision
of cyst.
following
Note
lack
removal
of epithelial
of cyst
lining.
on May
6, 1964.
Postoperative
course
SUMMARY
The foregoing case manifests the classic diagnostic features of nasoalvcolar cyst, except for t,he fact that. no epithelial layer was present. This absence 01’ epithclium is unique, but it is apparent that a correct diagnosis of r~asoalvrolar cysts is contingent upon a combination of clinical, roentRcno~raghic, and microscopic studies. REFERENCES
1. Thoma, K. II., and Goldmnn, H. JI. : Oral Pathologv, rd. .i, Pt. Mosby Company, pp. 820-821. H. (+.: Color Atlas of 2. Colby, R. A., Kerr, D. A., a,nd Robinson, Philadelphia, 1961! J. B. Lippincott Company, p. 29. A Textbook of 3. Shafer, W. G., Hmr, M. K., and Levy, R. M.: Philadelphia, 1963, \V. 13. Hsundws Company, 1,. 69. 4. Bhaskar, R. N.: Synopsis of Oral Pathology, St. Louis, 1961, ‘1’hl~ p. 200.
Louis,
IHAO,
Oral
Pathologv,
cd.
L’,
Oral
Pathology,
~1.
2,
(‘. T’. MOSll~
1’11~ (:. Y.
~‘ompxny,