Nasolabial cysts: Clinical features, diagnosis, and treatment

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Abstract

The aim of this study was to review our experience, examine the clinical and pathological features of nasolabial cysts, and to provide a basis for the diagnosis and treatment in an Asian population. We made a retrospective review of patients with nasolabial cysts who were treated at the Department of Otolaryngology, Tan Tock Seng Hospital between January 1999 and December 2004. Clinical data, presenting symptoms, clinical features, pathological findings, preoperative investigations, treatment, and outcome were analysed for each case.

We found 17 patients with nasolabial cysts. The findings of adult onset, higher incidence among women and preponderance on the left side confirmed current opinion. The clinical diagnosis of nasolabial cyst was accurate in all cases. Preoperative computed tomograms (CTs) done for one patient did not alter the management. All patients had the cysts excised completely through a sublabial incision. Breaches of the nasal vestibular mucosa healed spontaneously without repair. Histopathological examination showed that cysts were lined with pseudostratified columnar (n = 9), stratified squamous (n = 4), mixed respiratory and squamous epithelium (n = 3), and simple cuboidal epithelium (n = 1). No patient developed complications or recurrences.

Nasolabial cysts are relatively common in Singapore, and the diagnosis must be kept in mind if they are to be treated early. Diagnosis is based on clinical features and the treatment of choice is complete excision.

Introduction

Nasolabial cysts were first described by Zuckerkandl in 18821 and are also known as nasoalveolar cysts. The term “nasolabial” was coined by Rao,2 and is a more accurate description than “nasoalveolar”. Although nasolabial cysts are well-recognised clinical entities, they have been described as uncommon or rare.1, 3, 4, 5 In a review of 8000 cystic lesions of the oral cavity over a 10 year period, Allard5 identified only seven cases of nasolabial cysts. In his series, Kuriloff described 26 cases seen over 18 years.1 However, a recent series3 reported 8 cases in one year and suggested that nasolabial cysts may be more common than previously thought. Many lesions probably remain undetected unless and until they become infected or are associated with facial deformity.

Patients typically complain of deformity and nasal obstruction. Clinically, these non-odontogenic cysts present as smooth, fluctuant soft-tissue masses between the upper lip and nasal aperture, with obliteration of the nasolabial fold and elevation of the nasal ala. Bilateral cysts are rare Fig. 1.

Slow painless enlargement of the swelling may develop over several years, but patients may present with an acutely painful swelling if the cyst becomes infected. Less commonly, extension of infection from these cysts may mimic facial cellulitis, periodontal abscess, acute maxillary sinusitis, or a nasal furuncle.

The aim of this study was to review our experience, examine the clinical presentation and pathological features of nasolabial cysts locally, and to provide a rationale for their diagnosis and treatment.

Section snippets

Patients and methods

Eighteen patients diagnosed with nasolabial cysts were treated at the Department of Otolaryngology, Tan Tock Seng Hospital from January 1999 to January 2004. One patient was excluded because the records were incomplete. The clinical charts of the remaining 17 patients were reviewed, and data collected about history, clinical presentation, preoperative investigations, histopathology, treatment, complications, and outcome. Specimens of tissue were available for all patients, and the histological

Results

There were 6 men and 11 women, with a mean age of 41 years (range 31–75) (Table 1). The duration of symptoms at the time of presentation varied from 1 week to 2 years. Many of the lesions had previously been seen by family physicians and other practitioners. They were most commonly diagnosed as hypertrophied inferior turbinates, nasal vestibular abscess, or facial cellulitis with or without abscess.

In 5 of 17 patients, the cyst was infected at initial presentation, with acute enlargement, pain,

Discussion

The incidence of nasolabial cysts in the Western world is relatively low. Recent publications have suggested that they may be more common in other parts of the world.3, 4 In this series with a largely Oriental population, 18 cases were encountered over a 5-year period. Nasolabial cysts have been reported to be more common in women,2, 3, 4, 5, 6 and on the left side, and we have confirmed these findings.

Nasolabial cysts are thought to be developmental, arising from non-odontogenic epithelium.

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