Nasolabial cyst (also known as nasoalveolar cyst or Klestadt`s cyst) is a rare non-odontogenic, soft-tissue, developmental cyst occurring inferior to the nasal alar region. The cyst is derived from epithelial cells retained in the mesenchyme after fusion of the medial and lateral nasal processes and the maxillary prominence during fetal life or due to the persistence of epithelial remnants from the nasolacrimal duct extending between the lateral nasal process and the maxillary prominence.
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Demographics and clinical presentation
Nasolabial cyst occur 3 times as commonly in women as men. Most patients present in the fourth decade of life.
The patient usually presents with a slowly enlarging asymptomatic swelling. Patients usually seek medical advice on secondary infection of the cyst or due to the resulting disfigurement.
On palpation, there is a non-tender, fluctuant, mobile swelling. The soft-tissue swelling may obliterate the nasolabial fold, elevate the ala or the floor of the nose (or both) and fill in the labial vestibule intraorally, with or without nasal obstruction. The lesion may spontaneously rupture and drain orally, nasally or, occasionally via a cutaneous fistula.
Besides the presence of a non-tender fluctuant swelling in the alar region, the radiographic findings help to establish the diagnosis.
Radiographic finding of cyst in the nasolabial region that are separated from bony structure and teeth is suggestive of nasolabial cyst.
Computed tomography (CT) shows a well-demarcated, rounded, homogeneous, low-density soft tissue lesion at the nasolabial region. An evidence of scalloping and bone remodeling may be depicted.
Magnetic resonance imaging (MRI) shows the characteristics of fluid in T1 (low intense) and T2 (bright) views.
Treatment and prognosis
Its treatment is surgical excision through sublabial incision. There is no tendency for recurrence if it was removed completely. Malignant transformation is rare.
The differential diagnosis should include odontogenic, developmental and neoplastic lesions.
- odontogenic cyst - periapical inflammatory lesion (granuloma, cyst or abscess) that have thinned out the bone ; careful examination of the adjacent teeth and testing its vitality can help to rule out this possibility. OPG will show evidence of non vital tooth with radiolucency.
- dentigerous cyst - also need to be excluded. Usual radiographic appearance of dentigerous cyst is that of a well-demarcated radiolucent lesion attached at an acute angle to the cervical area of an unerupted tooth.
Another possible cyst of non-odontogenic origin is the epidermoid or epidermal inclusion cyst. As opposed to the normal pink or bluish coloration of a nasolabial cyst, this cyst is yellow hue in color.
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