Bilateral nasoalveolar cysts

BILATERAL

NASOALVEOLAR

Thomas A. Burtschi, 1)epnrtnlent

CASE

of Surgery,

CYSTS

D.D.S.,* and Roy A. Stout, D.D.S.,“* University

of Texas Medical

Galveston, Texas

Branch

REPORT

A 57-year-old Caucasian woman in minimal distress was admitted to John Sealy Hospital a chief complaint of swelling under the left ala of the nose. Present History.-Four days prior to admission the swelling arose to slightly more than its present dimension under the left ala of the nose and protruded into the vestibule There was no temperature elevation at the time of of the nose on that side (Fig. 1). admission. The patient was in minimal pain, and there was a swelling 4 cm. in diameter in the labial vestibule apical to the maxillary left incisors. The upper left central and lateral incisors were nonvital, with no discoloration. Roentgenograms taken prior to admission indicated a cyst of the maxilla, with resorption of 1 to with

Fig.

‘Resiclent, Oral **Colonel, DC, Professor of Surgery.

and Maxillofacial USA (Retired)

Surgery. : Chief of

Oral

271

and

l.-Left

profile

Maxillofacial

of

face.

Surgery

Sept. and

27, 1960. Associate

Fig. 2.-Topographic projection. cious area on right side of maxilla, lateral incisors. Sept. 37, 1960.

Note with

Fig.

of first

3.-Postoperative

intraoral

view

area of present some resorption

cyst. 1961

involvement on left aide and suspiof the maxillary left central and

Xote

loss

Past History.-The patient stated that thirty-five an incision in the area presently involved. In May, 1960, a right nrphrectomy was performed a kidney stone and chronic infection.

years

of incisors

eallivv

on left

:I ryst

si~lts. Feb.

20,

11acL IICCII rlrained

via

at

John

Scaly

Hospital

because

of

Volume 16 Number 3

BILATERAL

NASOALVEOLAR

273

CYSTS

negative and Systemic Recierc.-The findings of a systemic review lvere essentially noncontributory. Operatiae Proce&re.--Under general anesthesia with nasotracheal intubation, an adequate mucoperiosteal flap was raised from the cervical margins of the teeth and the cyst was enucleated from the intraoral approach. The cyst was found to indent the bone, leaving a smooth-surfaced cavitation. The lining membrane was nowhere contiguous with the membrane lining the maxillary sinus, and there was no connection with the suspected process on the right side. The pulp canals of the incisors appeared to be scaled by secondary dentine, and the teeth were left in place for further evaluation. The specimen was submitted for histologic examination, which revealed an epithelial lining composed of both stratified squamous epithelium and ciliated pseudostratified columnar epithelium, predominantly the latter. The teeth were subsequently extracted because of a mildly suppurative process. It was decided that good healing should be allowed to take place before further disposition was made of the process on the right side (Fig. 3). Two months later a similar swelling appeared in the right vestibule of the nose, lifting the ala. This swelling was not so pronounced as that on the left side had been. X-ray contrast-media study disclosed no encroachment or other involvement of the maxillary sinus by the cyst on the right side. ,4 roentgenogram taken after injection of contrast medium is shown in Fig. 4.

Fig. %-Topographic

projection.

Note syringe

contrast medium (Iodochloral) in place. Jan. 16, 1961.

in second

cyst

with

An opening was maintained in the right vestibule of the nose for i Cdecompression” for a period of three months, during which time the cyst appeared to diminish in size by about two thirds. This dimunition in size was probably the result of thickening of the lining membrane and partial return of normal contour due to the resilience of the surrounding tissues. Under local anesthesia, the cyst was enucleated through an incision in the mucolabial fold and was found to indent the bone much as the first cyst had, also without involvement of the lining membrane of the maxillary sinus. The postoperative course was uneventful. Histologic examination of the cyst revealed both stratified squamous epithelium and ciliated pseudostratified columnar epithelium.

274

Fig.

B.-Postoperative

roentgenogram increased opacity

taken six nlonths after on both sidva of maxilla.

Fig.

6..--l,eft

profile

of face

cnuclmtion of second -1ug. 4. 1961.

cyst.

Note

BILATERAL

Volume 16 Number 3

NASOALVEOLAR

275

CYSTS

Healing and consolidation have been normal, with no subsequent complications (Fig. 5). The patient’s facial appearance was greatly improved by the surgical removal of the two cysts (Figs. 6 and 7).

Fig.

‘I.-Full-face

view.

Note

normal

nasolabial

folds.

SUMMARY Histologically and clinically, these cysts were compatible with the nasoalveolar type of cyst. Hence the diagnosis of bilateral nasoalveolar cysts (classification according to Bernie+). The past history of incision and drainage of the cyst on the left side thirty-five years previously is thought to be commensurate with the size of the cyst, the amount of bone indentation, and the asymptomatic resorption of two teeth. Likewise, the cyst on the right side is believed to have been of many years’ duration, as evidenced by the amount of bone indentation. The impression received during the surgical procedures was that the cysts were lying within soft tissue in approximation to the bone, resultin g in gradual bone resorption. REFERENCE

1. Bernier, J. L. : Company.

The Management

of

Oral

Disease,

St. Louis,

1955, The C. V. Mosby