Journal of Orofacial Sciences

Vol. 4 Issue 2 December 2012

133
Address for correspondence:
Dr. A Sri Kennath J Arul,
No.7A, VOC Street, Alagappan Nagar,
Madurai, Tamil Nadu - 625 003, India.
E-mail: drkennath@gmail.com
Nasolabial cyst: Report of a case
A. Sri Kennath J. Arul, Sonika Verma, A. Sri Sennath J. Arul
1
, Rashmika Verma
2
Department of Oral and Maxillofacial Pathology, Best Dental Science College, Madurai,
1
Medical Practitioner,
Tamil Nadu, India,
2
Dental Surgeon, Rotorua, New Zealand
ABSTRACT
The nasolabial cyst is an uncommon non-odontogenic cyst arising in the maxillofacial tissues.
This lesion presents in an extraosseous location in the region of the nasolabial fold and
can cause swelling in the furrow, alar nose elevation, and upper lip projection. Despite the
uncommon occurrence of nasolabial cysts, it is important to recognize the characteristics of
this lesion. The paper documents the presentation of nasolabial cyst in a 33 year old woman
and discusses considerations related to the diagnosis.
Key words: Cyst, diagnosis, nasolabial, non-odontogenic
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DOI:
10.4103/0975-8844.106212
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INTRODUCTION
The nasolabial cyst (NC) is a rare
non-odontogenic cyst originating in the
maxillofacial soft tissues.
[1]
It represents
about 0.7% of all cysts in the maxillofacial
region,
[2]
2.5% of the non-odontogenic cysts.
[1]

Many authors believe that its prevalence is
actually higher than that presented in the
literature; however, due to misdiagnosis,
indexes remain low.
[1]
These cysts, unless infected, cause
painless swelling around the nasal
vestibule and upper lip, and infrequently
lead to nasal stuffiness.
[3,4]
Typically, they
appear as a swelling at canine fossa, upper
lip, gingivo-labial sulcus, nasal alae and
nasal vestibule.
[3]
Despite the fact that
they are soft tissue cysts and are situated
extra-osseously, they may sometimes
cause bone destruction.
[5]
The initial
diagnosis and treatment is usually made
in early stages because the lesion causes
cosmetic problems; very rarely it becomes
large in dimensions.
Commonly seen in adults, it has peak
prevalence in the 4
th
-5
th
decade of life.
[6]
A
greater incidence is seen in females (4:1).
It is usually unilateral in occurrence with
no predilection in side.
[2]
However, 11.2%
cases have been reported to be bilateral.
[7]
This paper documents the presentation
of nasolabial cyst in a 33 year old woman
and discusses considerations related to the
diagnosis.
CASE REPORT
A 33 year old woman was referred to our
service for the evaluation of a painless
swelling lateral to right ala of the nose
that had appeared one month earlier with
gradual evolution. Medical history was
non-contributory to the present complaint.
Extra-oral examination revealed a
diffuse swelling lateral to right ala of
the nose resulting in elevation of alae
and obliteration of the nasolabial fold
[Figure 1a]. On palpation, the swelling
was soft in consistency, fluctuant and
non-tender. On intra-oral examination,
swelling distending the right maxillary
labial sulcus [Figure 1b] was evident that
was soft, fluctuant and non-tender on
palpation.
A history of extraction with respect to
permanent maxillary right first molar
and maxillary left first premolar done
two years back was the only past dental
intervention. The teeth in the vicinity of
the swelling showed proximal caries but
were tested vital.
Intra-oral periapical and panoramic
radiographs revealed no obvious bony
changes. Maxillary occlusal view revealed
slight erosion of right side of the palate due
to pressure exerted by the lesion [Figure 2].
Case Report
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Arul, et al.: Nasolabial cyst
Journal of Orofacial Sciences
Vol. 4 Issue 2 December 2012
134
Aspiration of the swelling yielded a straw-colored fluid
[Figure 3]. Based on clinical and radiographic diagnosis,
a working diagnosis of nasolabial cyst was made. The
clinical differential diagnosis included epidermoid
inclusion cyst, salivary gland cyst.
Under local anesthesia, using a vestibular incision,
the cysts were enucleated and submitted for
histopathological examination. Microscopic evaluation
revealed a cystic lumen lined predominantly by
pseudo-stratified columnar epithelium with varying
number of goblet cells [Figure 4a] with part of lining
composed of cuboidal epithelium [Figure 4b]. The
fibrous cystic wall was relatively acellular, densely
collegenous and exceedingly hemorrhagic. The features
were consistent with the diagnosis of nasolabial
cyst. Post-operative follow up at 8 months showed
uneventful healing without evidence of recurrence.
DISCUSSION
The nasolabial cyst is a developmental, non-odontogenic
cyst that most commonly involves the nasal furrow
region.
[8]
According to Allard, the first description of this
entity is recorded by Zukerkandl in 1882.
[9]
It has been
given many names such as Klestadts cyst, nasoalveolar
cyst, nasal vestibular cyst, mucoid cyst of the nose, and
nasal wing cyst.
[10]
Regarding the pathogenesis, various theories of origin
have been proposed. The first suggested that it is a
retention cyst arising from inflamed mucus glands.
[11,12]

Klestadt first postulated an embryologic origin for
these cysts and considered that these lesions must
originate from embryonic epithelium, entrapped in the
developmental fissures between the lateral nasal and
maxillary processes.
[13]
Since then, many authors have
classified this entity based on Klestadts embryologic
theory as a fissural cyst. The third theory and the most
accepted one raised by Bruggemann is that it arises
from the remnants of the lower anterior part of the
nasolacrimal duct.
[14]
The clinical presentation is typical with an asymptomatic
spherical swelling beneath the nasal ala causing its
elevation and obliterating the nasolabial fold. Lesion
distends the mucolabial sulcus intra-orally and can
cause discomfort in denture users.
[2]
Most often patient
Figure 1a: Extra-oral photograph showing elevation of right nasal
alae and obliteration of the nasolabial fold
Figure 1b: Intra-oral photograph depicting the swelling distending
right maxillary labial sulcus
Figure 2: Maxillary occlusal radiograph revealed slight erosion of
right side of the palate Figure 3: Aspiration yielded straw-colored fluid
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Arul, et al.: Nasolabial cyst
Journal of Orofacial Sciences
Vol. 4 Issue 2 December 2012
135
may seek treatment because of the noticeable deformity,
as was in the present case.
The diagnosis is essentially clinical. Bi-digital palpation
reveals a fluctuating tumefaction between the floor of
the nasal vestibule and the gingivolabial sulcus, which
helps to confirm the diagnosis. Radiograms do not detect
this soft tissue lesion except when it causes significant
maxillary bone erosion.
[15]
Cohen and Hertzanu
reported a case of NC with a high growth potential that
resulted in the erosion of maxillary alveolus, invaded
the supporting structures in the region of incisor teeth
and caused their displacement.
[16]
In the present case,
the occlusal radiograph revealed pressure erosion on
right side of the palate, but there was no displacement
of teeth. The teeth in the lesional area are vital unless
affected by the pathosis unrelated to the cyst.
[2]
In the
present case, there was no focus of dental infection in
the lesional area and the teeth tested vital.
The differential diagnosis for a non-painful vestibular
soft-tissue swelling within the anterior maxillary-alar
region is not extensive, once conditions other than
benign cysts are excluded. However, only nasolabial
cyst presents exclusively in this area. Other soft-tissue
lesions that can occur in this region include periapical
inflammatory lesions (granuloma, cyst or abscess)
that have perforated the bone. Vitality testing of the
adjacent teeth can help to rule out this possibility. Very
rarely, aggressive developmental odontogenic lesions,
such as keratocyst, extend through the bone cortex to
cause soft-tissue swelling. The long-standing nature
of this lesion and the limited bone involvement made
this diagnosis improbable. Developmental gingival
cyst of the adult has a predilection for the bicuspid or
canine region and might have been considered in this
case. However, this lesion is usually localized in the
gingival or contiguous alveolar mucosa and would not
cause the distension of the vestibular mucosa that
characterizes nasolabial cyst. Another possible cyst of
non-odontogenic origin is the epidermoid or epidermal
inclusion cyst. A distinguishing feature of this very rare
cyst may be its yellow hue, as opposed to the normal
pink or bluish coloration of a nasolabial cyst. Mucous
extravasation cyst could also be considered. However,
in such cases there is often a history of deflation and
inflation as mucus within the lesion is periodically
expressed and regenerated. As noted earlier, numerous
non-odontogenic benign or malignant neoplasms may
present in this area. Of particular significance are
salivary gland neoplasms arising from minor salivary
glands.
[17]
Various treatment modalities have been considered
for NC including injection of sclerosing agents,
marsupalization and surgical enucleation. However,
surgical enucleation through sublabial approach is the
most accepted treatment modality. Recurrence have
never been reported.
[2]
Malignant transformation is rare
and has been documented in only one case.
[18]
CONCLUSION
Nasolabial cyst must be kept in mind in differential
diagnosis of nasal vestibule, nasal base, and sublabial
area. Although uncommon in occurrence, it is imperative
for the clinician to make an accurate diagnosis and
provide appropriate treatment.
[2]
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Figure 4a: Photomicrograph of histopathologic section reveals
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with varying number of goblet cells with hemorrhagic fibrous
connective tissue wall
Figure 4b: Photomicrograph of histopathologic section reveals
cystic lumen lined by cuboidal epithelium with fibrous connective
tissue wall
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How to cite this article: Arul AJ, Verma S, Arul AJ, Verma R. Nasolabial
cyst: Report of a case. J Orofac Sci 2012;4:133-6.
Source of Support: Nil, Confict of Interest: None declared
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