Patent nasopalatine ducts after rapid maxillary expansion

Patent nasopalatine ducts: an update of the literature and a series of new cases

PURPOSE

The objective of this review is to present an update and summary of clinical findings of cases with a patent nasopalatine duct (NPD) reported in the literature from 1881 to 2016.

METHODS

Previous articles and reviews about patent NPDs were studied and copies of all original publications were obtained for data verification. Furthermore, a literature search was conducted. In addition, the study sample was complemented with four cases recently seen in our institution.

RESULTS

Ten out of 67 published cases were to be excluded for this analysis due to misinterpretation or misreporting in previous articles. Overall, 57 cases with NPD patency could be analyzed. Males outnumbered females in a ratio of 2:1. The mean age (when this information was available) was 34.1 ± 17.6 years (range 6-69 years). NPDs were located bilaterally (60%), unilaterally (20%) or centrally (20%). Complete or partial patency was reported in 73.9 and 26.1%, respectively. 74.1% of patients presented a variety of clinical signs and symptoms. The ability of the patient to produce a squeaky or whistling sound was the most frequent clinical finding (23.8%).

CONCLUSIONS

Caution must be exercised when reading review articles about NPD patency since wrong data have been copied in several subsequent publications. Since epidemiological data are missing with regard to patent NPDs, age and gender predilections are not warranted. Bilateral occurrence and full patency were prevailing features in the evaluated case reports of patent NPDs.

Surgical treatment option of the patent nasopalatine duct: a case report

The nasopalatine duct (NPD) is a bilateral, epithelium-lined oronasal communication formed in the early fetal period. It connects the oral cavity with the nasal cavity within the primary palatal process. Mostly, the NPD obliterates during prenatal development and only epithelial remnants can be found after birth. A persistent NPD is therefore considered a developmental abnormality that often exists undetected without any clinical signs of discomfort. The presence of a persisting NPD, however, can be associated with pain sensation in the anterior maxilla. Differential diagnosis of the patent NPD is of importance, in order to prevent unnecessary therapy, such as endodontic treatment or tooth extractions. The present case report describes the diagnostic procedures, surgical treatment and follow-up of the patent NPD in a 53-year-old female patient suffering from maxillary pain caused by a patent NPD.

Asymptomatic patent nasopalatine ducts after rapid maxillary expansion

This article describes the clinical case of a patient, a 13-year-old boy, in whom the appearance of patent nasopalatine ducts was noted after having a rapid maxillary expansion performed. To confirm this finding, inspection and radiographic examination were performed in which gutta-percha cones were used as contrast. The patient related no symptoms or discomfort due to the ducts. The patient was followed up for a period of 6 months, during which he was instructed as regards correct cleaning to prevent the accumulation of food and infection.

Patent nasopalatine duct: a diagnostic pitfall

We describe a patient in whom the combination of excessive air in the maxillary sinus and the presence of a patent nasopalatine duct led to misdiagnosis and subsequent treatment of a non-existent oroantral perforation. When a radiograph indicates that antral involvement during removal of a maxillary molar is unlikely, and yet a routine postoperative nose-blowing test contradicts this, the possible presence of a pre-existent oronasal communication such as a patent nasopalatine duct should be considered.