Diagnosis and management of bilateral nasolabial cysts

An atypical presentation of a bilateral nasolabial cyst: a case report

The nasolabial cyst is a rare, non-odontogenic, soft tissue cyst that develops submucosally in the anterior nasal floor. This cyst accounts for 0.7% of all non-odontogenic cysts. Bilateral nasolabial cyst represents only 10% of the cases. This cyst originates from the remnants of embryonic nasolacrimal duct tissue. Generally, patients present with swelling and facial deformity and rarely local pain. The definite diagnosis should be based on clinical, radiological and above all histopathologic findings. The treatment is enucleation of the cystic tissue. Following is a case report of a bilateral nasolabial cyst in a 40-year-old woman who presented with a chronic nasal obstruction.

Nasolabial cyst in an elderly patient: A case report

INTRODUCTION

Nasolabial Cyst (NC) or Klestadt's cyst is a relatively rare soft tissue developmental lesion of nasal alar region accounting for 0.7% of all non-odontogenic cysts. NC usually presents as an asymptomatic swelling located in the anterior region of the maxilla lateral to midline-resulting in obliteration of nasolabial sulcus, nasal vestibule and maxillary labial sulcus and facial asymmetry-often observed on early stages by most patients due to cosmetics issues.

CASE REPORT

A 76-year-old woman was referred for evaluation of an asymptomatic facial swelling in the left upper lip region lasting 20 years. Extraoral clinical examination showed a left-sided swelling lateral to midline near to the alar base resulting in facial asymmetry. Intraoral clinical examination revealed the presence of a single painless well-defined nodular, sessile, non-tender swelling covered by normal oral mucosa, and located in the upper labial mucosa in the left incisor's region. An excisional biopsy was performed, and microscopic examination revealed a cystic cavity lined by cuboidal to columnar epithelium with mucous cells. The underlying connective tissue showed chronic inflammatory infiltrate close to muscular tissue. Patient recovery was uneventful, and there are no signs of local recurrence in a 2-year clinical follow-up.

CONCLUSION

Clinicians should consider NC when evaluating an upper lip swelling extending to the nasolabial region of the elders.

Cysts and Pseudocysts of the Oral Cavity: Revision of the Literature and a New Proposed Classification

This article includes a comprehensive and up-to-date review on the cysts of the oral cavity. Several classifications of odontogenic (OC) and non-odontogenic (non-OC) oral cysts and the surrounding regions have been proposed. We suggest a new critical classification based on an established relationship between anatomical area, histological origin and clinical behavior (frequency, rate of recurrence, malignant potential). Moreover, the differential cytokeratin (CKs) expression of the various cysts is reported as epithelium-specific markers of differential diagnosis. Finally, issues related to differential diagnosis and therapeutic approaches of the cysts included in the two groups are described.

Bilateral nasolabial cyst

Nasolabial cyst is an uncommon non-odontogenic extraosseous cyst located in the nasolabial fold. Bilateral nasolabial cysts are rarer and only few cases have been reported. We describe a case of two asymptomatic masses of the nasal ala areas, which prove to be nasolabial cysts in a 30-year-old Moroccan woman.

[The nasolabial cyst encountered in the practical work of the otorhinolaryngologists]

Two clinical observations of nasolabial cyst of uni- and bilateral localizations are reported. The comprehensive characteristic of nasolabial cysts is presented with special reference to the principal diagnostic criteria for this pathology and the potential diagnostic errors.

An Unexpected Rhinoplasty Complication: Bilateral Nasolabial Cyst

The nasolabial cyst also known as Klestadt's cyst is a rare non-odontogenic soft tissue lesion of the nasal alar region. Aetiopathogenesis of the nasolabial cysts is controversial. Embryonic and developmental theories were considered at pathogenesis of the nasolabial cyst. In addition, surgical or non-surgical trauma is one of the possible theories. This paper reports a case of a 33-year-old male patient that presented with bilateral nasolabial cysts after rhinoplasty and alar base reduction.

LEVEL OF EVIDENCE V

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Nasolabial cysts: A systematic review of 311 cases

OBJECTIVES/HYPOTHESIS

Nasolabial cysts are rare nonodontogenic cysts arising commonly in the nasal alar region. Intraoral sublabial resection of nasolabial cysts is considered the standard treatment modality. In the past 16 years, transnasal endoscopic marsupialization has emerged as an alternative approach for these lesions. A systematic review on this entity was performed to evaluate management and outcomes.

DATA SOURCES

PubMed/MEDLINE Database.

METHODS

A search of literature including nasolabial cysts, nasoalveolar cysts, and Klestadt's cysts was performed using the PubMed/MEDLINE database. Parameters regarding presentation, treatment, imaging, histology, and complications were extracted and subsequently analyzed.

RESULTS

Seventy-nine articles with 311 patient cases were included in this analysis. In cases reporting location, nasolabial cysts occurred 46.9%, 37.5%, and 10.9% on the left, right, and bilaterally, respectively. The most common presenting complaint was facial swelling in 168 out of 237 patients (70.9%). Computed tomography was the most commonly employed imaging study (n = 170). Surgical excision of nasolabial cysts was performed using an intraoral sublabial approach in 184 patients. Seventy-nine patients underwent endoscopic transnasal marsupialization. The most common complication following surgical treatment of nasolabial cysts was postoperative facial/perinasal swelling. Three and two recurrences were reported in the sublabial excision group and transnasal marsupialization group, respectively. Mean follow-up time was 20.0 months.

CONCLUSIONS

Endoscopic transnasal marsupialization is a relatively new alternative to intraoral sublabial resection of nasolabial cysts, with similar efficacy. The rates of postoperative swelling, pain, and recurrence are similar in both groups.

A rare case of bilateral nasolabial cysts

Nasolabial cysts are rare non-odontogenic cystic lesions representing around 0.7% of all maxillofacial cysts. They usually present as unilateral painless swellings, sometimes with epiphora and dacryocystitis as well as pain in cases of rapid growth or infection. We have reviewed the literature and present an extremely rare case of bilateral nasolabial cysts in a young Afro-Caribbean man presenting with chronic nasal blockage, epiphora and rhinorrhoea. We describe our successful surgical management using a sublabial approach for complete excision, leading to a disease-free outcome at 6 months follow-up. Other modalities have been described, from endoscopic marsupialisation to simple aspiration. However, with the exception of complete surgical excision, all other surgical techniques are associated with a high recurrence rate. We therefore advocate complete surgical excision as described below for optimal results.