Dr. T. Balasubramanian M.S. D.L.O.
Synonyms: Nasoalveolar cyst, Fissural cyst, Nonodontogenic cyst, soft tissue cyst.
Introduction: Nasolabial cyst is a rare non odontogenic tumor arising from maxillo facial soft tissues. This condition was first described by Zuckerkandl in 1882.
Theories of nasolabial cyst / Klestadt cyst: Two main theories have been proposed to explain the etiopathogenesis of nasolabial cyst.
Theory I: Postulates that nasolabial cyst arises from entrapped nasolacrimal tissue.
Theory II: Was proposed by Klestadt. He postulated that nasolabial cysts are embryonal fissural cysts.
Classic features of nasolabial cyst:
1. This lesion classically is seen in the extraosseous region of the nasolabial fold.
2. There is swelling over the nasolabial fold
3. Projection of upper lip
4. Common in females
5. Usually it is unilateral
6. There is no displacement of teeth
Image showing nasolabial cyst on the left side. Note the cyst pushing the inferior turbinate medially on the left side
Patients usually complains of swelling adjacent of the nose. This cyst can also erode the anterior wall of the maxilla. In rare cases radicular absorption are also known to occur. The lesion is usually painless. Presence of pain in nasolabial cyst indicates infected nasolabial cyst.
Nasolabial cyst should be clinically differentiated from epidermoid cyst. Nasolabial cyst usually has a bluish tinge, while epidermoid cyst is usually yellow in color. Odontogenic cysts should be ruled out in all cases of nasolabial cyst by dental xrays.
Nasolabial cyst is lined by pseudostratified columnar epithelium. Numerous goblet cells can be seen within the lining epithelium. These goblet cells are responsible for collection of straw colored fluid inside the cyst. In long standing cases the cyst wall may contain fibrous tissue. The presence of this fibrous tissue in the cyst capsule will facilitate complete enucleation of the cyst during surgery.
Small cysts can be surgically extripated via sublabial approach. Care must be taken when large cysts are to be operated. Nasal mucosa may be perforated when large cyst is to be removed. In such cases the torn nasal mucosa should be sutured back in place.
Figure showing sublabial incision being used to excise nasolabial cyst
Figure showing the cyst rupturing on incision
Surgery can ideally be performed under local anesthesia. Sublabial approach is preferred as it avoids facial scarring.
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