Hindawi Publishing Corporation

Case Reports in Dentistry

Volume 2013, Article ID 869516, 4 pages
http://dx.doi.org/10.1155/2013/869516

Case Report
Nasopalatine Duct Cyst

Pratik Dedhia,1 Shely Dedhia,2 Amol Dhokar,1 and Ankit Desai3

1
Department of Oral Medicine and Radiology, Terna Dental College, Nerul, Navi Mumbai 400706, India
2
Department of Pediatric and Preventive Dentistry, Nair Hospital Dental College, Mumbai Central, Mumbai 400008, India
3
Department of Periodontics, Terna Dental College, Nerul, Navi Mumbai 400706, India

Correspondence should be addressed to Shely Dedhia; drshelyjain@gmail.com

Received 5 September 2013; Accepted 3 October 2013

Academic Editors: R. S. Brown, C. Evans, E. Hochuli-Vieira, K. Nakamori, and K. Seymour

Copyright © 2013 Pratik Dedhia et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The nasopalatine cyst is the most common epithelial and nonodontogenic cyst of the maxilla. The cyst originates from epithelial
remnants from the nasopalatine duct. The cells may be activated spontaneously during life or are eventually stimulated by the
irritating action of various agents (infection, etc.). It is different from a radicular cyst. The definite diagnosis should be based on
clinical, radiological, and histopathological findings. The treatment is enucleation of the cystic tissue, and only in rare cases a
marsupialisation needs to be performed. A case of a nasopalatine duct cyst in a 35-year-old male is reviewed. The typical radiologic
and histological findings are presented.

1. Introduction The present case of NPDC is one such typical pathology

with the classical presentation which could have been easily
The nasopalatine duct cyst (NPDC) was first ever described misdiagnosed as a periapical lesion.
by Meyer in 1914 [1, 2]. Nasopalatine duct cyst, also termed
as incisive canal cyst, arises from embryogenic remnants
of nasopalatine duct, the communication between the nasal 2. Case Report
cavity and anterior maxilla in the developing fetus. Most of
these cysts develop in the midline of anterior maxilla near the 2.1. History. A 35-year-old male reported to the dental clinic
incisive foramen [3]. It is one of the most common nonodon- with the chief complaint of painless swelling over the palate
togenic cysts of the oral cavity occurring in about 1% of the and anterior maxilla. The swelling was gradually increasing
population [4]. in size for the past 3 months with associated displacement of
NPDCs affect a wide age range; however, most present maxillary central incisors. There was no associated history of
in the fourth through sixth decades of life, and most studies trauma.
show a significantly higher frequency in men than woman, On examination, a well defined firm nontender swelling
with the ratio being 2.5 : 1 [5–11]. Patients may be asympto- was seen on the left side of anterior hard palate and crossing
matic, with the lesion being detected on routine radiographs; over the midline to the right side. The crown of left cen-
however, many will present with one or more symptoms. tral incisor was displaced labially and mesially, overlapping
Complaints are often found to be associated with an infection the crown of right central incisor (Figure 1). A provisional
of a previously asymptomatic nasopalatine duct cysts and diagnosis of periapical cyst was given but the vitality tests of
consist primarily of swelling, drainage, and pain [10, 12]. the central incisors were negative. The differential diagnosis
The vitality of nearby teeth should not be affected; however, was established with other conditions such as an nasopala-
it is not uncommon to see evidence of endodontic therapy tine duct cyst, enlarged nasopalatine duct, central giant
because the nasopalatine duct cyst was previously clinically cell granuloma, a root cyst associated to the upper central
misdiagnosed as a periapical cyst or granuloma. incisors, a supernumerary tooth follicular cyst, primordial
2 Case Reports in Dentistry

(a) (b)

Figure 1: Preoperative intraoral swelling.

Figure 3: Axial sections of CT scan showing the well-defined round

radiolucency.

Figure 2: Maxillary occlusal view showing well defined radiolu-

cency in the anterior maxilla.

cyst, and nasoalveolar cyst. Radiological investigations were

subsequently advised.

2.2. Radiographic Features. Maxillary occlusal radiograph Figure 4: Sagittal sections of CT scan.
showed a well-defined round radiolucency approximately
2.5 cm in size with corticated margins in the midline and
between the central incisors which was the typical radio-
graphic feature of NPDC (Figure 2). The lesion was causing
2.3. Treatment. A surgical enucleation was done with intact
displacement of the roots of the incisors. Superiorly it was
removal of the cyst (Figure 6) and the specimen was sent
extending till the floor of nasal fossa. Also there was deviation
for histopathological examination which showed cystic lining
of the nasal septum to the right side.
composed of stratified squamous epithelium about 2-3 cell
CT scan also showed a well-defined radiolucency in ante-
layer thick. Lining was flattened and showed pseudostratifi-
rior maxilla in the region of incisive canal, 2.6 cm × 2.8 cm
cation at places (Figure 7). This was conclusive for NPDC.
in size. Mesiodistally the radiolucency was causing displace-
ment of the roots of both maxillary central incisors and it was
not extending laterally beyond the roots of incisors. Inferiorly 3. Discussion
it was extending till the crest of interdental bone. Loss of
cortication was seen along the buccal and palatal aspects of NPDCs are usually central or unilateral with no prevalence
the lesion in the sagittal sections. The lesion was causing mild of side occurrence. Radiographically, they are seen as well-
elevation of the floor of nasal fossa in the anterior region with defined round or oval radiolucencies in the midline, although
deviation of the nasal septum to the right side (Figures 3, 4, some lesions may appear heart-shaped [6], either because
and 5). Mucosal polyp was seen associated with the floor of they become notched by the nasal septum during their expan-
left maxillary sinus. A radiographic diagnosis of NPDC was sion or because the nasal spine is superimposed on the
established and surgical enucleation was planned. radiolucent area.
Case Reports in Dentistry 3

Figure 5: Panoramic reconstruction of CT scan.

Figure 7: Photomicrograph of nasopalatine duct cyst showing strat-

ified squamous epithelium.

important that practitioners are aware of the features of the

NPDC.

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4 Case Reports in Dentistry

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