Braz. j. . vol.80 número5

BrazJOtorhinolaryngol.2014;80(5):448---450

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

www.bjorl.org

CASE

REPORT

Clinical,

tomographic

and

histopathological

aspects

of

the

nasopalatine

duct

cyst

夽

Aspectos

clínico-tomográfico-histopatológicos

do

cisto

do

ducto

nasopalatino

Janaina

Almeida

Mesquita

,

Anibal

Henrique

Barbosa

Luna

,

Cassiano

Francisco

Weege

Nonaka

_,

_Gustavo

_Pina

_Godoy

_,

_Pollianna

_Muniz

_Alves

a_{OdontologyProgram,UniversidadeEstadualdaParaíba(UEPB),JoãoPessoa,PB,Brazil} b_{UniversidadeFederaldaParaíba(UFPB),JoãoPessoa,PB,Brazil}

Received26October2012;accepted15December2012 Availableonline4July2014

Introduction

The nasopalatine duct cyst (NPDC) is a condition of non-odontogenicdevelopmentarisingfromtheproliferationof epithelialremnantsof thenasopalatineduct,whichexists throughout fetal life,and tends to regressafter birth. In some cases, remnants may remain, proliferate, and give rise to a cyst.1,2 _{It is a rare condition, usually affecting}

malesbetween30and60yearsofage.3_Itisusually

asymp-tomatic,growsslowly,andisdetectedafterroutineclinical andX-rayexaminations.4_{Whenswelling,drainage,andpain}

fromtheanteriorpalatearereportedintheselesions,they areassociatedwithsecondaryinfectionorpressureonthe nasopalatinenerve.2_{Onradiographicexamination,thecyst}

is seen in the midline as a heart-shaped radiolucency in theregionoftheanteriornasalspine.5,6 _{Thetreatment is}

夽 _{Pleasecitethisarticleas:MesquitaJA,LunaAHB,NonakaCFW,} GodoyGP,AlvesPM.Clinical,tomographic,and histopathological aspects of the nasopalatine duct cyst. Braz J Otorhinolaryngol. 2014;80:448---50.

∗_{Correspondingauthor.}

E-mail:jannalmeida@hotmail.com(J.A.Mesquita).

enucleationofthelesion,andhistopathologicalexamination toconfirmthediagnosis.

Case

report

A 41-year-oldfemaleleukoderma patientwasreferred by the orthodontist with a suspected maxillary injury. The patient had no complaints, and reported 11/21 extrac-tions due to caries as a child. On physical examination, no facialasymmetry was notedand mucosae were intact (Fig. 1A). Computed tomography (CT) showed a sin-gle hypodense and well-delineated lesion, approximately 1.0cm×0.7cm×0.8cminsize,followingthecourseofthe nasopalatineduct(Fig.1B).Excisionalbiopsywasperformed (Fig. 1C),and the specimen wassent to the Oral Pathol-ogyLaboratory,whereacysticcavitylinedbythincolumnar pseudostratifiedepithelium,consistingofonetothreecell layers and a dense fibrous cystic capsule, was observed on microscopic examination (Fig. 1D). A predominantly mononuclearinflammatoryinfiltratewasevidentinthecyst lumen.Fromtheclinical, tomographic,and histopatholog-ical findings, the diagnosis of nasopalatine duct cyst was confirmed.

http://dx.doi.org/10.1016/j.bjorl.2014.05.020

Clinical,tomographicandhistopathologicalaspectsofthenasopalatineductcyst 449

Figure1 (A)Intraoralclinicalappearance,withnoabnormalitiesonphysicalexamination.(B)AxialmaxillaryCTshowsthe medio-lateralviewofthelesion.Maxillarysagittalacquisitionshowsanteroposteriorandsuperoinferiorviews.(C)Surgicalcavityafter totalenucleationofthelesion.(D)Photomicrographshowsthepresenceofcysticlesionlinedbythinpseudostratifiedepithelium, anddensefibrouscapsulewithachronicinflammatoryinfiltrate(HE,40×).Withhighermagnification,thelowercornerontheright showsthepresenceofroundandflatcellsintheepitheliallining(HE,400×).

Discussion

There is a current consensus that NPDc development is related to the proliferation of epithelial remnants in the nasopalatine duct.2 _{Local trauma, the presence of}

infec-tionintheregion,racialandgeneticfactorshaveallbeen suggestedaspossiblecauses3_{;however,thetheoryof}

spon-taneousproliferationofepithelial remnantsappearstobe themostlikelyexplanationfordevelopmentofthelesion.1

Inthereportedcase,aninfectionhistoryduetotheloss ofsuperiorcentralincisorsfromcariesinchildhoodis sug-gestedtobeapredisposingfactor forCPDc development. However,afewstudiesreportdegenerativephenomenain thefetalnasopalatineduct,inwhichcasetraumaand infec-tioncouldnothaveoccurred.2

Imaging is essential in diagnosing and treating NPDc. In the reported case, a CT revealed the lesion to be approximately1.0cm,asizeforwhichenucleationis indi-cated.Radiolucency>0.8cminthisareashouldbesurgically explored, and if >1.4cm, an initial diagnosis of cyst is stronglysuggested.6

Microscopicanalysisofthis lesionwascharacteristicof NPDc. The presence of columnar pseudostratified epithe-liumandafibrouscysticcapsulehavealsobeenreportedin theliterature.4,6_{However,othertypesofepitheliallinings,}

such as stratified squamous epithelium and pseudostrat-ified cuboidal epithelium, have also been observed. The existenceofdiverseepitheliamightberelatedtothecyst positionwithin the duct.Nervous fibers, probably arising fromthe nasopalatine nerve, blood vessels, and mucosal secretingglands,canalsobefound.4

Bymeansoftheclinicalandradiographicaspects,the ini-tialdiagnosiswasnasopalatineductcyst,inwhichthefirst linetreatmentisusuallysurgicalenucleationafter consid-erationofthelocationandsizeofthelesion.3

Final

comments

450 MesquitaJAetal.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

References

1.CicciùM,GrossiGB,BorgonovoA,SantoroG,PallottiF,Maiorana C.Rarebilateralnasopalatineductcysts:acasereport.Open DentJ.2010;4:8---12.

2.Pavankumar K, Sholapurkar AA, JoshiV.Surgical management ofnasopalatineductcyst:casereport.RevClínPesqOdontol. 2010;6:81---6.

3.FrancolíJE,MarquésNA,AytésLB,EscodaCG.Nasopalatineduct cyst:reportof22casesandreviewoftheliterature.MedOral PatolOralCirBucal.2008;13:438---43.

4.BachurAM,SantosTCRB,SilveiraHM,PiresFR.Cistododucto nasopalatino: considerac¸ões microscópicas e de diagnóstico diferencial.Robrac.2009;18:58---62.

5.SuterVGA,SendiP,ReichartPA,BornsteinMM.Thenasopalatine ductcyst:ananalysisoftherelationbetweenclinicalsymptoms, cyst dimensions, and involvement of neighboring anatomical structuresusingconebeamcomputedtomography.JOral Max-illofacSurg.2011;69:2595---603.