- A 17-year-old male presented with an 11-month history of a recurrent non-painful swelling in his left nasolabial region that had been progressively increasing in size. - On examination, a 7x6 cm soft, fluctuant, and mobile mass was observed occupying the region between the left upper alveolar ridge and zygomatic arch, causing facial asymmetry and deformation. - Nasolabial cyst was diagnosed based on the clinical presentation and location of the mass. The treatment plan was to admit the patient and perform an enucleation of the cyst via a transoral sublabial surgical approach under local anesthesia.

1. Nasolabial Cyst
Dr. NZANZU KIKUHE, Resident II
ENT Department
Makerere University( Uganda)

2. Patient presentation
• NAME: Ssekitereko Arafat
• GENDER: Male
• AGE: 17 yrs
• OCCUPATION: student
• RELIGION: Muslim
• ADRESS: Kawempe
• TRIBE: Buganda

4. Complain
nasolabial swelling/ 11/12

5. History of Presenting Illness
• An 11 months history of a non-painful swelling
of the left nasolabial region which has
progressively increased in size and caused
facial deformity without facial numbness.
• The swelling was managed operatively 4/12
ago at Naguru Hospital .
• 2 weeks later it reappeared and increased
compared to the first presentation.

6. History of Presenting Illness
• No associated headache, fever and
convulsions
• No other similar swelling noticed by the
patient

7. History of Presenting illness
• NASAL:
• No nasal blockage
• no nasal pain
• No rhinorrhea; No epistaxis
• No postnasal discharge
• No loss of smell.
• No snoring
• No sneezing

8. History of Presenting Illness
ORAL:
• no difficulty in opening the mouth
• No difficulty in swallowing
• No pain in swallowing
• No dental pain
• No chewing difficulty

9. History of Presenting Illness
ORAL:
• No change of voice
• No cough
• No difficulty in breathing

10. History of Presenting Illness
Otological
• No reduced hearing
• No pain of the ears
• No ears discharge
• No tinnitus
• No vertigo

11. History of Presenting illness
OPTHALMOLOGICAL
• no diplopia
• No epiphora
• No loss of vision
• No eye swelling
• No eye pain

12. Review of Systems
• CVS: unremarkable
• RS: unremarkable
• MSK: unremarkable

13. Past medical history
• No any chronic illness reported
• No history of trauma or fractures

14. Family History
• No similar condition
• No history of chronic illness
• No history of tumours

15. Social history
• Sero status is unknown,
• Doesn’t drink alcohol or smoke

16. Drug history
• Not known allergic to any medication
• has not been on long term medication

17. Examination
• GC fair state, not pale, jaundice, afebrile 37 C
• Extra oral examination reveals:
Asymmetry of the face
Deformation of the left nasolabial sulcus and
elevation of the ala nasi on the left side

18. Examination
• There is a mass 7x6 cm occupying the region
between the left upper alveolar ridge to the
inferior border of the left zygomatic arch.
• The mass is soft, fluctuant, circumscribed, non-
tender, and mobile over the underlying structures

19. Examination
Nose: unilateral elevation of the nasal ala to
the left side, left nasal cavity normal, Right
nasal cavity normal.
• Intra oral examination shows:

20. Examination
Mouth:
No Trismus
a smooth, mucosal covered mass in the
gingival labial sulcus is seen at the upper left
side displacing the upper left canine tooth.
 The mass is rounded non tender not bleed in
contact and clearly circumscribed.

22. Examination
Hard palate normal
No bulge of the soft palate
The gloss alveolar sulcus is free
• No pathology seen in glosso alveolar and
gingivo alveoalar Sulci

23. Examination
Ears:
• Normal auricular contour
• Normal EAC No mass seen
• TM: normal
Eye: Normal

24. Examination
CVS:
PR= 84, BP= 110/80mmHg, normal precordium, Apex in the 6th ICP,
normal first and second heart sounds
RS:
RR=18/min, Normal vesicular breathing, normal chest expansion and
movement
PA: No organomegaly
MSK: No other structural deformities, or swellings

25. Summary
• 17yr male History of a recurrent non-painful
mass of the left nasolabial region which is
progressively increasing in size, is soft,
fluctuant, circumscribed, non-tender, and
mobile
• Obvious asymmetry of the face

26. Summary
• Deformation of the left nasolabial sulcus and
elevation of the ala nasi on the left side
• a smooth, mucosal covered mass in the
gingival labial sulcus

27. IMPRESSION
Nasolabial cyst
B. Differential diagnosis
1. Odontogenic cyst
2. Dentigerous cyst
3. Dermoid or epidermoid cyst
4. Fibrous-osseous disease

28. Plan
1. Admit in 3C ENT
2. Head X-Ray(done normal)
3. Enucleation by transoral sublabial approach
under LA
4. Wound closure: suturing

30. Literature Review

31. Introduction
• Cyst is defined as pathologic cavity;
 having fluid, semifluid, or gaseous contents
and
 which is not created by accumulation of pus.
 It is frequently but not always lined by
epithelium

32. Introduction
• In the formation of a cyst, the epithelial cells
first proliferate and later undergo
degeneration and liquefaction.
• The liquefied material exerts equal pressure
on the walls of the cyst from within

33. Introduction
• Cysts grow by expansion and thus displace the
adjacent structures by pressure. May can
produce expansion of the cortical bone.
• On a radiograph, the radiolucency of a cyst is
usually bordered by a radiopaque periphery of
dense sclerotic bone.

34. CLASSIFICATION OF CYST
Orofacial Cysts
Epithelial (true cyst)
Odontogenic
Based on etiology
Developmental
Inflammatory
Based on site of origin
Reduced enamel
epitelium
Cell rest of Serre
Cell rest of
Malassez
unclassified
Non odontogenic
Non Epithelial (pseudo cyst)

35. EPITHELIAL/TRUE CYST
ODONTOGENIC NON ODONTOGENIC
FISSURAL CYST
-median anterior
maxillary cyst
-nasopalatine duct cyst
-nasolabial cyst?
-globulomaxillary cyst
-median mandibular
cyst
DEVELOPMENTAL CYST
-palatal cyst of neonate
-thyroglossal tract cyst
-benign cevical
lymphoepithelial cyst
-epidermoid and dermoid
cyst
Heterotopic oral
gastrointestinal cyst

36. ODONTOGENIC
BASED ON ETIOLOGY
DEVELOPMENTAL CYST
-gingival cyst of infants
-gingival cyst of adults
-odontogenic keratocyst
-dentigerous cyst
-eruption cyst
-lateral periodantal cyst
-botryoid odontogenic
cyst
-glandular odontogenic
cyst
-calcifying odontogenic
cyst
INFLAMMATORY
-periapical cyst
-residual cyst
-paradental cyst
BASED ON SITE OF ORIGIN
1)REDUCED ENAMEL EPITHELIUM
-dentigerous cyst
-eruption cyst
2)CELL REST OF SERRE
-odontogenic keratocyst
-gingival cyst of newborn
-gingival cyst of adults
-lateral periodontal cyst
-glandular odontogenic cyst
3)CELL REST OF MALASSEZ
-periapical cyst
-residual cyst
4)UNCLASSIFIED
-calcified odontogenic cyst
-paradental cyst

37. Introduction
• Nasolabial cyst (also known as nasoalveolar
cyst or Klestadt`s cyst , nasal vestibule cyst,
nasal wing cyst ) is a rare non-odontogenic,
soft-tissue characterized by its extra osseous
location in the nasal alar region
• The first documentation of nasolabial cyst was
by Zuckerkandl in 1882

38. Epidemiology
• According to recent reviews on this item,
nasolabial cyst is rarely diagnosed in Western
countries but may be more frequent in others
regions, e.g. Eastern Asia
• African statistics including Ugandan’s are not
available

39. Epidemiology
• It is classified as a non-odontogenic,
extraosseous cyst, is usually located in the
area of the nasolabial sulcus, just below the
ala nasi, accounts for approximately 7% of
maxillary cysts, and is unilateral in 90% of
cases

40. Epidemiology
• Nasolabial cysts predominantly affect women
(75% of cases) and arise most commonly in
the fourth and fifth decades of life

41. Pathogenesis
• pathogenesis of nasolabial cysts is still
uncertain
• Two theories have been suggested to explain
the origin of nasolabial cyst:

42. Pathogenesis
1. Klestadt in 1913 suggested that they arise
from trapped epithelium at the point where
the maxillary, medial nasal, and lateral nasal
processes fuse which become inclusion cyst(
fissural cyst)
• However, a lack of evidence to support the
idea of embryonic epithelial entrapment in
this location prompted many researchers to
discard this hypothesis

43. Pathogenesis
2. Bruggeman in 1920 had suggested that
nasolabial cysts develop from remnants of the
embryonic nasolacrimal ducts( developmental
cyst).
• This theory is supported by the fact that the
nasolacrimal ducts are lined with pseudostratified
columnar epithelium, which is the type of
epithelium found in the nasolabial cyst cavity
• Currently, it is the most widely accepted theory

44. Diagnosis
1) Symptoms and signs
• Nasolabial cyst is usually asymptomatic
• The patient presents only when the cyst
become infected or when it causes unilateral
fullness in the nasolabial region
• patients initially noticed a fullness in the
nasolabial region before it becomes
symptomatic

45. Diagnosis
• Due to the peculiar presentation and location
of these lesions, their diagnosis is almost
exclusively clinical
• The most common sign is enlargement
causing facial asymmetry due to displacement
of the upper lip, with elevation of the ala nasi
and effacement of the nasolabial sulcus

46. Diagnosis
• Local pain, nasal obstruction, and concomitant
infection—which can lead to abrupt
enlargement of the lesion—may also be
present

47. Diagnosis
• Occasionally in late presentation, it can
present with nasal obstruction when it pushes
on the inferior turbinate causing it to
medialize
• On inspection, nasolabial cyst appears to be
either normal pink or bluish in color

48. Diagnosis
• The cyst is best palpated bimanually with a
finger in the floor of the nose and other in the
labial sulcus
• The cyst appears underneath the ala nasi as a
painless fluctuant swelling extending laterally
into the cheeks, often obliterating the
nasolabial sulcus, and extending anteriorly
into the lip and mucobuccal vestibule

49. 2) Imaging
• Periapical radiographs, nasolabial cysts may
present as a radiolucent area in the apical
region of the maxillary incisors
• Standard occlusal views show posterior
displacement of the radiopaque line
corresponding to the bony margins of the
anterior nasal aperture

50. Diagnosis
• In the absence of radiographic findings and
when a more precise analysis of the borders of
the lesion is required, CT SCAN is the imaging
modality of choice
• CT scans usually reveal a homogeneous, well-
delimited cystic lesion in the lateral nasal
region cystic lesion, with no contrast uptake

51. Diagnosis
• Larger lesions may be associated with bone
remodeling of the underlying maxilla
• CT is able to demonstrate the soft tissue
nature as well as bony involvement
• As the cyst is benign there is no bony erosion
other than expansible lesion causing thinning
of the bone

52. Diagnosis
• Ultrasonography does not offer much other
than to confirm its cystic content
• Magnetic resonance imaging (MRI) shows the
characteristics of fluid in T1 (low intense) and
T2 (bright) views.

53. Diagnosis
3) Histopathology
• Histopathological examination reveals ciliated
pseudostratified columnar epithelium and,
occasionally, stratified squamous epithelium
• In a scanning electron microscopy study of the
inner surface of nasolabial cysts, non-ciliated
columnar epithelium with basal cells and
goblet cells is found

54. Differential diagnosis.
• Differential diagnosis of the nasolabial cyst includes:
1. Odontogenic cyst: It originates in the tissue of the
tissue so careful examination will show evidence of
non vital tooth with radiolucency
2. Dentigerous cyst : most common sites are
mandibular third molar and maxillary third molar,
Large cysts tend to expand the outer plate (usually
buccally)
2

55. Differential diagnosis.
3. Dermoid or epidermoid cyst: As opposed to
the normal pink or bluish coloration of a
nasolabial cyst, this cyst is yellow in color
4. Fibrous-osseous disease: painful, hard, bone
is replaced by fibrous tissue

56. Treatment
• Treatment is aimed to prevent infection, to
ameliorate a cosmetic deformity, and to
establish a histopathological diagnosis
• The current treatment of nasolabial cyst is
complete excision
• Surgical enucleation is easily achieved via a
transoral sublabial approach

57. Treatment
• Transnasal marsupialisation of nasolabial cyst
which open into nasal cavity have reported no
recurrence of cyst
• Recently, the alternative transnasal route was
proposed by some authors : endoscopic
approach extends the nasal floor to the
former cystic cavity and thus prepares an air-
containing sinus

58. Treatment
• This technique appears to allow sufficient
drainage of the new sinus and there were no
signs of cyst recurrence
• Other mode of treatment that had been
described are simple aspiration, injections
with a sclerosing agent, destruction by
cautery, needle aspiration, and incision and
drainage. However, these method are
associated with high recurrence rates

59. MERCI POUR VOTRE ATTENTION