Mandible & maxilla
Cysts of the jaw
Nasopalatine duct cyst
Last author update: 1 July 2015
Last staff update: 26 April 2023
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PubMed Search: Nasopalatine cyst [title]
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Diagrams / tables | Clinical features | Diagnosis | Prognostic factors | Radiology description | Radiology images | Case reports | Treatment | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Martinez A. Nasopalatine duct cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillanasopalatine.html. Accessed May 29th, 2023.
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
- First: originates from spontaneous proliferation of remnants of nasopalatine duct within incisive canal
Diagrams / tables
Images hosted on other servers:
Fissural cysts
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
- Enlarged incisive fossa
- On radiograph and CT, is well circumscribed, rounded or heart shaped radiolucency of anterior maxilla
Radiology images
Images hosted on other servers:
Heart shaped radiolucent lesion
Expansile maxillary alveolus
Well defined round radiolucent area
Well defined radiolucency
Homogeneous high intensity area
Saggital / axial CT images
Axial sections of CT
Case reports
- 26 year old woman with unusually large destructive nasopalatine duct cyst (J Maxillofac Oral Surg 2013;12:100)
- 29 year old man treated with with bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst (Clin Pract 2015;5:748)
- 35 year old man with nasopalatine duct cyst (Case Rep Dent 2013;2013:869516)
- 35 year old man with nasopalatine duct cyst mistaken for clinical radicular cyst (BMJ Case Rep 2014 Mar 18;2014)
- 36 year old woman with nasopalatine duct cyst ( Indian J Otolaryngol Head Neck Surg 2013;65:385)
Treatment
- Surgical excision is most common, but marsupialization has also been performed
Clinical images
Images hosted on other servers:
Intraoral swelling
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:
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
Images hosted on other servers:
Stratified squamous and pseudostratified columnar epithelium
Flattened cuboidal epithelium
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)
Additional references
