Mandible / maxilla
Fissural and other non-odontogenic cysts
Nasolabial cyst

Author: Anthony Martinez, M.D. (see Authors page)
Editor: Kelly R. Magliocca, D.D.S., M.P.H.

Revised: 21 June 2018, last major update June 2015

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Nasolabial cyst [title]

Cite this page: Martinez, A. Fissural and other non-odontogenic cysts: nasolabial cyst. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/mandiblemaxillanasolabial.html. Accessed September 22nd, 2018.
Definition / general
  • A rare, developmental non-odontogenic cyst that occurs in the soft tissues of the upper lip lateral to midline
Terminology
  • Klestadt cyst
  • Nasal alveolar cyst
  • Nasoalveolar cyst
  • Nasal wing cyst
  • Nasal vestibule cyst
  • Mucoid cyst of the nose
Epidemiology
  • Rare, represents:
    • < 1% of jaw cysts
    • 2.5% of non-odontogenic cysts
  • Adults, peak prevalence in fourth and fifth decades
  • 3:1 predilection for women
Sites
  • Nasolabial region of the facial soft tissues
  • Does not involve the underlying bone, therefore nasoalveolar cyst is a misnomer
Etiology
  • Unsettled, but two main theories:
  • First suggests remnants of the embryonic nasolacrimal ridge, duct or rod as origin
    • Support for this theory is the immunohistochemical protein expression pattern which is very similar to the physiologic pattern of normal nasolacrimal duct epithelium
  • Second theory, now less favored:
    • Suggests entrapped epithelial remnants along fusion line of medial nasal, lateral nasal and maxillary processes as an origin
Clinical features
  • Benign, slow growing cystic mass usually less than 3 cm in size
  • Usually asymptomatic, rarely nasal obstruction or reports of pain if infected
  • Most common patient concern is swelling
  • Mass effect results in distention of nasolabial fold and elevation of the ala of the nose, extraorally
  • Presentation could result in clinical differential diagnosis of odontogenic infection
  • Intraorally, obliterates the mucolabial fold
  • 10% of cysts are bilateral
Diagnosis
  • Diagnosis dependent of clinical, radiologic and pathologic correlation
Prognosis and treatment
  • Malignant transformation has never been reported
Radiology description
  • On CT, will appear as ovoid, well circumscribed lesion, distortion of the affected nasolabial area / base of the nose
  • Aside from subtle surface saucerization of bone, bone changes are not identified with this soft tissue cyst
Case reports
Treatment
  • Surgical excision, performed intraorally, is most common
  • Transnasal marsupialization has also been performed
Clinical images

Images hosted on other servers:
Missing Image

Lateral cephalograph

Missing Image

Raised left ala of nose

Missing Image

Extraoral swelling

Missing Image

Obliteration of labial sulcus

Missing Image

Endoscopic view

Gross description
  • Rubbery, smooth surfaced mass, ballotable soft tissue cyst
  • Sectioning reveals cystic and fibrous areas, without internal surface papillary projections
Gross images

Images hosted on other servers:
Missing Image

Surgical specimen

Microscopic (histologic) description
  • Histologic examination often reveals lining of multilayered or pseudostratified, cuboidal to columnar epithelium
  • Presence of true 'ciliated' epithelium has been described but there is a question whether true cilia remains
  • Other combinations possible:
    • Bilayered epithelium with a cuboidal basal layer and a columnar luminal layer that contains interspersed scattered mucinous goblet cells
    • Both stratified squamous and cuboidal epithelium
    • Cuboidal epithelial lining only
    • A minority exhibit pseudostratified columnar, stratified squamous and cuboidal epithelium together
  • Scattered interspersed luminal goblet cells are common
  • Focal squamous metaplasia or apocrine changes may be present
  • Cyst wall is composed of hypocellular fibrous connective tissue and may include skeletal muscle
  • Inflammation may be present if a history of secondary infection
Microscopic (histologic) images

Images hosted on other servers:
Missing Image

Pseudostratified cylindrical epithelium

Missing Image

Cyst lining

Missing Image

Stratified squamous epithelium

Immunohistochemistry
Electron microscopy description
  • Bilayered structure of the lining epithelium with cuboidal basal layer and columnar luminal cells and mucous (goblet) cells
  • Nonmucous luminal cells frequently feature prominent rough endoplasmic reticulum and numerous submembranous secretory granules, some with electron dense cores
  • Microvilli decorated with glycocalix, but no true cilia present, which is in keeping with the newer literature
Differential diagnosis
  • Cyst of the incisive papilla:
    • Soft tissue cyst with similar histologic features to nasolabial cyst, but distinguished by anatomic site
    • Cyst of the incisive papillae occurs within the soft tissue of the anterior hard palate only and shows no communication with the upper lip or nasal area
  • Cystic salivary gland neoplasms (benign or malignant) could show overlapping features with nasolabial cyst, particularly on small biopsies:
  • Dilated salivary duct due to obstruction:
    • Soft tissue cystic proliferation, typically associated with inflammation in fibrous connective tissue wall
  • Epidermal inclusion cyst:
    • Soft tissue cyst distinguished from nasolabial cyst by keratinizing epithelium
  • Glandular odontogenic cyst:
    • Is an intraosseous cyst
    • If bony cortical perforation has occurred, then a sampling of the 'soft tissue' component of the cyst lining will create a diagnostic dilemma
  • Hidrocystoma:
    • Soft tissue cyst of the skin, usually occurring in the periorbital region. Thin, uniform lining, usually 2 cell layers
  • Nasopalatine duct cyst:
    • Is an intraosseous cyst with histologic features similar to nasolabial cyst
    • If bony cortical perforation has occurred, then a sampling of the 'soft tissue' component of the cyst lining will create a diagnostic dilemma
    • Contents of incisive foramen typically identified in the surgically resected specimen (peripheral nerve, cartilaginous rests, vascular channels)