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Nasopalatine cyst
NASOPALATINE HARRIS BLAKE, D.D.S.,*
CYST
AXI) I?RB:I) S. BI,.~E:,
I).I).S.,
N
PATERSON,
N.
4.
ASOPALATINE or inaisi\-e canal cysts ;IYC t’ormed by ~)rolifwatic~u (II’ epithelial remnants itI the incisive v;~na.l. ( ‘linically, they Itlay Sllcj\\, bulging of the anterior part uf’ thv p;tlwtv at the midline. 'l'ht~g art OI'I(~II found on routine roentpt~nog~aphic~ esamin;liion. I’ilill rll;ly 01’ III;I~ Ilo1 Ibt’
il
present.
Radiographically, the wpiws of the itlcisor t&h appear to taxitend itrio the cystic area. Therefore. it is IL~Y~~~I~~ to diflerentiate t.he nasopalat i ttv cyst from the radicular cyst and frwn~ t tlcl tlent,igcr,uns cyst. II is. liowc~~~~r~, possible for different types 01’ c2ysl.s to (It:\-rlol) silnullilneouslp. The hislor~ and clinical and roent,gellogr~ll)llic csanlinations. together with {III awuratv electric vitality test, are of I hc utmost irnlmrtance in tllr differeniial cliagrwsis. The treat,ment consists of surgical relrlo\-al of the cyst through n I~;IIiIi;Il approach. Case Report
Jntraoral examination sllo\\t~l in the region of the incisive anal, overlying the swelling KVBSnormal right lateral incisor revealed no remaining anterior tecltll were witllin
3 slight I~ulging on the anterior part of thr hard pxl:cti* The rII,,cos:l which was soft and tclntlrr on palpation. Tlll~ in color and sho~~veti no fluid discharge on pressurl‘. rcqonsc to the> vitality test,; pulp tc3t findings of 1II(~ normal
limils
Roentgenographic Examination.-~l’ller~ was a large radiolucent area in t,he rnitlliur* of the anterior region of the hard palate ahout 2 cm. in diameter (Fig. I\. There was AI preoperativt~ also a small radiolucent area apical to the right maxillar>lateral incisor. lesion \yhich WI:: diagnosis of nasopalatine cyst wa.* m:td~ associated with :L smaller prriapical considered of odontogenic origin. Operation.-The patient. R as premedicstrtl with I)emerol hydrochloride: 75 11jg.. hypodermically. Under local anesthesia an incision was made on the palatal side, 2 LIIIII. It extended from the first premolar on one side to the firhl below the gingival margin. premolar on the other. The mucoperiosteal flap was elevated and retracted (Fig. 2). _\ The Iron> small amount of bone overlying the cyst was removed and the sac enucleat,ell. edges were smoothed, debris was removed, ant1 sulfanilimicle powder was placed into tllrs The palatal mucosa was returned to its normal position and t,he incision sut.ur.~l wound. Perri~illin. with interrupted Triple 0 silk ~utnrrs. to the remaining gingival margin Thr specimen was ~uhmittr~~l fret intrarmlsculxrl~. 500,000 units, was administ,ered microscopic examination. *Oral
Surgeon,
Rarnert
Memo&+1
Hospital,
Faterson,
1062
K-w
Jersey.
NASOPALATINE
Fig.
2.-Exposure
CYST
of the
cyst.
Microscopic examination of a swtiou stlowcti a wall matlc up of connective tissue. The peripheral portion was dense amI sho\vetl focal infiltration by lymphocytes and plasma cells. The infiltration became difYuse and ulow extensive toward the lumen. The epithelial lining was frequently missing. iVhere pwseu1., it v:rrietl Iwtween multilayered stratified to single layered cylindrical c’ells, frequently showing viliatinn (%‘ig. 3). Tn areas thr epithelium showed keratohyalinr. Here I)olvlllorphonuclear leukocytes were numerous. with nasopalatine c_sl. Diagnosis was inflamed cyst vvotl, compatit)le
Postoperative Treatment.--Tht~ patient received -MI,IW(I units of penicillin intr:tltillscularly once daily for the next three days. The .sutures wvrv removed on the fifth postoperative day. The patient made an uneventful recover?. A postoperative roent,geno:~ratrr taken ontx VPRI after the operation shows rrgenerntioll of tmne in the cystic cayit,\ (Fig. 4). Comment ‘I’he nasopalatine cyst, n(ust lw differentiated I’twnl the raclieulat* ;Irltl tkntigerous qztq hut two or all thwe ~nay de\-elol) sinrultnnrously. I~ornt gx~t~c)p*;~n~s iu t,he c~cclusnl and prriapi~al pro.je&)ns. plus awwate use of the l)tilt) tester, ant1 cwnlplete history ill~tl c~liuienl es;tn~iuat~ious ilI*e nccess;r~y itI the tlifierentia.1 diagnosis. The preoperative diaguosis must, he suhstnutiatetl lq miewscopic csa willatic)11 of the tissue. The nasopalatine cyst (*(jut>bins dliatetl epithelium. In this wzw the area apical to the right litter;11 in&or WRSttwrtetl lutrr 1)~ IIIWIIS of root canal theraljy and apicoectonly. References I. Hernier, J. L.. and Tiecke, R. \V.: Incisive Clanal (:yst, .J. Oral Surg. 8: 254, 195tl. 2. Halman, I.: C&s of the Jaws, .J. Oral Snrg. 9: 203, 1951. :%. Thoma, Kurt H.: Diagnosis and Treatment of Odontogrnic and E’issural Cysts, O~ar, PATH. 3: ‘)(;I, I%(). HURG., ORAL ~kl)., ANI) ORAL 1. Thoma, Kurt H.: Oral Surger)-, vol. 2, St. T,ollih, 101x. The C’. Y. Mosl,y C‘orllpally. pp. 1160-l 164. 17 (‘IIV’RUII ST.
CYST
AXI) I?RB:I) S. BI,.~E:,
I).I).S.,
N
PATERSON,
N.
4.
ASOPALATINE or inaisi\-e canal cysts ;IYC t’ormed by ~)rolifwatic~u (II’ epithelial remnants itI the incisive v;~na.l. ( ‘linically, they Itlay Sllcj\\, bulging of the anterior part uf’ thv p;tlwtv at the midline. 'l'ht~g art OI'I(~II found on routine roentpt~nog~aphic~ esamin;liion. I’ilill rll;ly 01’ III;I~ Ilo1 Ibt’
il
present.
Radiographically, the wpiws of the itlcisor t&h appear to taxitend itrio the cystic area. Therefore. it is IL~Y~~~I~~ to diflerentiate t.he nasopalat i ttv cyst from the radicular cyst and frwn~ t tlcl tlent,igcr,uns cyst. II is. liowc~~~~r~, possible for different types 01’ c2ysl.s to (It:\-rlol) silnullilneouslp. The hislor~ and clinical and roent,gellogr~ll)llic csanlinations. together with {III awuratv electric vitality test, are of I hc utmost irnlmrtance in tllr differeniial cliagrwsis. The treat,ment consists of surgical relrlo\-al of the cyst through n I~;IIiIi;Il approach. Case Report
Jntraoral examination sllo\\t~l in the region of the incisive anal, overlying the swelling KVBSnormal right lateral incisor revealed no remaining anterior tecltll were witllin
3 slight I~ulging on the anterior part of thr hard pxl:cti* The rII,,cos:l which was soft and tclntlrr on palpation. Tlll~ in color and sho~~veti no fluid discharge on pressurl‘. rcqonsc to the> vitality test,; pulp tc3t findings of 1II(~ normal
limils
Roentgenographic Examination.-~l’ller~ was a large radiolucent area in t,he rnitlliur* of the anterior region of the hard palate ahout 2 cm. in diameter (Fig. I\. There was AI preoperativt~ also a small radiolucent area apical to the right maxillar>lateral incisor. lesion \yhich WI:: diagnosis of nasopalatine cyst wa.* m:td~ associated with :L smaller prriapical considered of odontogenic origin. Operation.-The patient. R as premedicstrtl with I)emerol hydrochloride: 75 11jg.. hypodermically. Under local anesthesia an incision was made on the palatal side, 2 LIIIII. It extended from the first premolar on one side to the firhl below the gingival margin. premolar on the other. The mucoperiosteal flap was elevated and retracted (Fig. 2). _\ The Iron> small amount of bone overlying the cyst was removed and the sac enucleat,ell. edges were smoothed, debris was removed, ant1 sulfanilimicle powder was placed into tllrs The palatal mucosa was returned to its normal position and t,he incision sut.ur.~l wound. Perri~illin. with interrupted Triple 0 silk ~utnrrs. to the remaining gingival margin Thr specimen was ~uhmittr~~l fret intrarmlsculxrl~. 500,000 units, was administ,ered microscopic examination. *Oral
Surgeon,
Rarnert
Memo&+1
Hospital,
Faterson,
1062
K-w
Jersey.
NASOPALATINE
Fig.
2.-Exposure
CYST
of the
cyst.
Microscopic examination of a swtiou stlowcti a wall matlc up of connective tissue. The peripheral portion was dense amI sho\vetl focal infiltration by lymphocytes and plasma cells. The infiltration became difYuse and ulow extensive toward the lumen. The epithelial lining was frequently missing. iVhere pwseu1., it v:rrietl Iwtween multilayered stratified to single layered cylindrical c’ells, frequently showing viliatinn (%‘ig. 3). Tn areas thr epithelium showed keratohyalinr. Here I)olvlllorphonuclear leukocytes were numerous. with nasopalatine c_sl. Diagnosis was inflamed cyst vvotl, compatit)le
Postoperative Treatment.--Tht~ patient received -MI,IW(I units of penicillin intr:tltillscularly once daily for the next three days. The .sutures wvrv removed on the fifth postoperative day. The patient made an uneventful recover?. A postoperative roent,geno:~ratrr taken ontx VPRI after the operation shows rrgenerntioll of tmne in the cystic cayit,\ (Fig. 4). Comment ‘I’he nasopalatine cyst, n(ust lw differentiated I’twnl the raclieulat* ;Irltl tkntigerous qztq hut two or all thwe ~nay de\-elol) sinrultnnrously. I~ornt gx~t~c)p*;~n~s iu t,he c~cclusnl and prriapi~al pro.je&)ns. plus awwate use of the l)tilt) tester, ant1 cwnlplete history ill~tl c~liuienl es;tn~iuat~ious ilI*e nccess;r~y itI the tlifierentia.1 diagnosis. The preoperative diaguosis must, he suhstnutiatetl lq miewscopic csa willatic)11 of the tissue. The nasopalatine cyst (*(jut>bins dliatetl epithelium. In this wzw the area apical to the right litter;11 in&or WRSttwrtetl lutrr 1)~ IIIWIIS of root canal theraljy and apicoectonly. References I. Hernier, J. L.. and Tiecke, R. \V.: Incisive Clanal (:yst, .J. Oral Surg. 8: 254, 195tl. 2. Halman, I.: C&s of the Jaws, .J. Oral Snrg. 9: 203, 1951. :%. Thoma, Kurt H.: Diagnosis and Treatment of Odontogrnic and E’issural Cysts, O~ar, PATH. 3: ‘)(;I, I%(). HURG., ORAL ~kl)., ANI) ORAL 1. Thoma, Kurt H.: Oral Surger)-, vol. 2, St. T,ollih, 101x. The C’. Y. Mosl,y C‘orllpally. pp. 1160-l 164. 17 (‘IIV’RUII ST.