Mandible & maxilla

Cysts of the jaw

Nasopalatine duct cyst



Last author update: 1 July 2015
Last staff update: 13 October 2023

Copyright: 2004-2019, PathologyOutlines.com, Inc.

PubMed Search: Nasopalatine cyst [title]


Anthony Martinez, M.D.
Kelly Magliocca, D.D.S., M.P.H.
Page views in 2023: 6,050
Page views in 2024 to date: 1,623
Cite this page: Martinez A. Nasopalatine duct cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillanasopalatine.html. Accessed March 19th, 2024.
Definition / general
  • Most common intraosseous, nonodontogenic cyst of jaw (maxilla)
Terminology
  • Median anterior cyst
  • Midline maxillary cyst
  • Anterior median palatine cyst
  • Incisive canal cyst
  • Incisor duct cyst
Epidemiology
  • Occurs in ~1% of population
  • Represents 1.7 - 11.9% of all jaw cysts
  • Usually adults, peak prevalence in fourth and fifth decades
  • More common in males (ranges in literature from slightly more common to up to 3x more common in males than females)
Sites
  • Exclusively in maxilla, located in anterior midline of hard palate
    • Occasionally can produce a midline anterior maxillary swelling if cyst erodes bone of anterior maxilla
  • Cysts can form within the incisive canal located in palatine bone behind alveolar process of maxillary central incisors
  • Some doubt the existence of median palatine cyst as a distinct entity and characterize all nonodontogenic cysts of the midline maxilla regardless of anterior or midline location, as nasopalatine duct cysts
  • Rarely, may develop within incisive papilla, the anterior soft tissue protruberance that overlies the incisive foramen
    • In this instance, is termed cyst of incisive papilla, or cyst of palatine papilla
Etiology
  • Two main theories:
    • First: originates from spontaneous proliferation of remnants of nasopalatine duct within incisive canal
      • Exact trigger that stimulates development is unknown, but factors proposed include trauma and infection
    • Second: theory now out of favor; originates from trapping of epithelial remnants during embryologic fusion between nasal cavity and anterior maxilla
Clinical features
  • Usually asymptomatic, may have swelling of palate in relation to maxillary central incisors
  • Occasionally produces a midline anterior maxillary swelling if cyst erodes bone of the anterior maxilla
  • Can present with painful swelling or drainage, or tooth root displacement
Diagnosis
  • Diagnosis dependent on clinical, radiologic and pathologic correlation
Prognostic factors
  • Although extremely rare, malignant transformation (squamous cell carcinoma) has been reported
  • Relapse rate varies but usually from 0 - 11%
  • Hyperkeratotic features associated with higher relapse rate (closer to 30%)
Radiology description
  • Differential diagnosis:
    • Enlarged incisive fossa
      • The incisive foramen by convention is not expected to exceed 6 mm
      • A radiolucency in this region with ill defined borders is regarded as a large incisive fossa
      • Distinction from a nasopalatine duct cyst can be made clinically by aspiration
    • Central giant cell granuloma
      • Can have similar radiologic findings
      • Histologic features of central giant cell granuloma consist of a proliferation of fibrous tissue, hemorrhagic focuses, hemosiderin deposits, osteoclast-like giant cells and reactive bone formation
    • Ameloblastoma
    • Keratocystic Odontogenic Tumor
    • Periapical (radicular) cyst
  • On radiograph and CT, is well circumscribed, rounded or heart shaped radiolucency of anterior maxilla
Radiology images

Images hosted on other servers:
Missing Image

Heart shaped radiolucent lesion

Missing Image

Expansile maxillary alveolus

Missing Image

Well defined round radiolucent area

Missing Image

Well defined radiolucency


Missing Image

Homogeneous high intensity area

Missing Image

Saggital / axial CT images

Missing Image

Axial sections of CT

Case reports
Treatment
  • Surgical excision is most common, but marsupialization has also been performed
Clinical images

Images hosted on other servers:
Missing Image

Intraoral swelling

Missing Image

Intraoperative view, cystic area

Gross description
  • Variable size, mean diameter ~1.5 cm
  • Sectioning reveals cystic and fibrous areas
Gross images

Images hosted on other servers:
Missing Image

Surgical specimen

Microscopic (histologic) description
  • Lined by stratified squamous epithelium alone or with pseudostratified columnar epithelium (variable cilia and goblet cells), simple columnar epithelium or simple cuboidal epithelium
  • Cyst wall is composed of fibrous tissue with nerves, cartilaginous rests, arteries and veins
  • The nasopalatine duct contains the nasopalatine nerve and the terminal branch of the descending palatine artery
Microscopic (histologic) images

Contributed by Kelly Magliocca, D.D.S., M.P.H.
Nasopalatine duct cyst

Nasopalatine duct cyst



Images hosted on other servers:
Missing Image Missing Image

Stratified squamous and pseudostratified columnar epithelium

Missing Image

Flattened cuboidal epithelium

Missing Image

Fibrous cyst wall with nerves

Differential diagnosis
  • Glandular odontogenic cyst:
    • Intraosseous developmental odontogenic cyst, may have ciliated or mucous cells within cystic lining
    • Should NOT have contents of incisive foramen (peripheral nerve, cartilaginous rests, muscular vascular channels)
  • Nasolabial (nasoalveolar) cyst:
    • Soft tissue (nonintraosseous) cyst with histologic features similar to nasopalatine cyst
    • Occurs in soft tissues of upper lip lateral to midline
    • Should not have contents of incisive foramen (peripheral nerve, cartilaginous rests, muscular vascular channels)
  • Periapical (radicular) cyst:
    • Most common inflammatory odontogenic cyst
    • Lined by stratified squamous epithelium of variable thickness, often with scattered ciliated cells
    • Derived from rests of Malassez
    • In nasopalatine cysts, the lamina dura is intact and the pulp is usually vital, but radicular cysts are associated with a pulpless tooth and involve a portion of the root, usually with loss of continuity of the lamina dura
  • Surgical ciliated cyst:
    • Postoperative "complication" with cystic expansion of respiratory epithelium within maxilla, may have ciliated or mucous cells within cystic lining
    • Usually located in posterior maxilla and lacks contents of incisive foramen (peripheral nerve, cartilaginous rests, muscular vascular channels)
Back to top
Image 01 Image 02