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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 12  |  Issue : 3  |  Page : 326-328

Nasolabial cyst in an unusual location within the upper lip – A rare case report


Department of Oral and Maxillofacial Pathology and Oral Microbiology, M.M. College of Dental Sciences and Research, M.M (Deemed to be University), Ambala, Haryana, India

Date of Submission28-Aug-2021
Date of Acceptance01-Apr-2022
Date of Web Publication15-Sep-2022

Correspondence Address:
Dr. Sushruth Nayak
Department of Oral and Maxillofacial Pathology and Oral Microbiology, M.M. College of Dental Sciences and Research, M.M (Deemed to be University), Mullana, Ambala - 133 207, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_130_21

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  Abstract 


The nasolabial cyst is a rare non-odontogenic cyst that develops between the upper lip and nasal vestibule. It has unsure pathogenesis. It has a history of slow-growing lesions, and clinically on palpation gives a floating touch. Usually, there is an elevation of the upper lip. The swelling usually, in most cases, is asymptomatic produces a localised swelling along with varying degrees of nasal obstruction. We present a case of a nasolabial cyst which was clinically diagnosed as a lipoma because of its unusual location in the upper lip in a 46-year-old man, which slowly increased in size over a period of 6 months with the association of slight pain on palpation and facial disfigurement. Our objective is to alert the dental professionals about the unusual presentation of nasolabial cyst in the upper lip, which may become a hurdle in clinical diagnosis.

Keywords: Nasolabial cyst, swelling, upper lip


How to cite this article:
Nayak S, Nayak P, Pathak K, Singh S, Karadwal A. Nasolabial cyst in an unusual location within the upper lip – A rare case report. Adv Hum Biol 2022;12:326-8

How to cite this URL:
Nayak S, Nayak P, Pathak K, Singh S, Karadwal A. Nasolabial cyst in an unusual location within the upper lip – A rare case report. Adv Hum Biol [serial online] 2022 [cited 2022 Oct 7];12:326-8. Available from: https://www.aihbonline.com/text.asp?2022/12/3/326/356102




  Introduction Top


Nasolabial cysts are uncommon soft-tissue non-odontogenic cysts that grow between the nasal vestibule and upper lip.[1] Ninety per cent of the cases are unilateral, and only about 10% show bilateral occurrence, with more female predilection in the fourth to fifth decades of life.[2] Zuckerkandl described the cyst for the first time in 1882, and ever since, many theories have been put forward regarding etiopathogenesis. However, only two main theories have been acknowledged. The first considers the nasolabial cyst to be in the category of fissural cysts, originating from epithelial remnants retained along the line of fusion of the lateral, medial and maxillary nasal processes.[3] The second, more believable and currently accepted theory suggests a possible embryonic origin from embryonic remainders of the inferior and anterior portion of the nasolacrimal duct.[4]

Nasolabial cysts in the majority of cases are unilateral with no side prevalence, but bilateral cases have also been reported.[5] It is lined by pseudostratified ciliated or non-ciliated columnar epithelium with goblet cells.[6] In this report, we have described a case of nasolabial cyst in an unusual site of the upper lip with its clinical features and histopathological diagnosis.


  Case Report Top


Clinically, the patient had a swelling in the right upper lip portion resulting in its elevation from the past 6 months [Figure 1]. The swelling was mobile on palpation and round in size, measuring about 5 cm × 5 cm without any discharge or change in the overlying skin colour. There was slight tenderness on palpation. There was no history of trauma or surgery at the site of the lesion. The clinical diagnosis of lipoma was made. After obtaining informed consent from the patient, an excisional biopsy was done, and the tissue was sent for histopathological examination. The grossed specimen was measuring about 2.2 cm × 1 cm, firm in consistency, cream to light brown, with an irregular surface. The tissue specimen was cut into two equal halves, and both were taken up for processing [Figure 2]. Hematoxylin and eosin-stained tissue section revealed the presence of pseudostratified ciliated columnar epithelial lining and connective tissue wall surrounding the cystic lumen. The connective tissue wall was composed of collagen fibre bundles, numerous ducts with eosinophilic coagulum within the lumen, chronic inflammatory cell infiltrates were seen mainly surrounding the ducts and transverse section of muscle tissue along with blood vessels [Figure 3]a and [Figure 3]b. Overall features were suggestive of a nasopalatine duct cyst involving the upper lip. Follow-up was done where the lesion showed complete healing.
Figure 1: Swelling in the right upper lip

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Figure 2: Grossed tissue specimen

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Figure 3: (a) Pseudostratified ciliated columnar epithelial lining surrounding the lumen. (b) Ducts with eosinophilic coagulum and presence of chronic inflammatory cells

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  Discussion Top


The nasolabial cyst is a rare condition seen in about 0.7% of all maxillofacial cysts and about 2.5% of non-odontogenic cysts in the maxillofacial region.[7] They have a predilection for the female sex,[4] and women show three times higher incidence in occurrence.[8],[9] They frequently occur during middle age, with a possible prevalence in persons of the black race.[8] We are report this case because of the unusual location (within the upper lip), which can put up a slight confusion in the clinician's mind regarding the diagnosis. In most of the cases reported in the literature, the site of occurrence was a labial vestibular area in the maxilla resulting in the elevation of the upper lip.

Clinically, the findings of nasolabial cysts are typical and are characterised by the presence of puffiness and slow growth at the bottom of the superior vestibular fornix, resulting in obliteration of the nasolabial sulcus, protrusion of the top lip and elevation of the wings of nostrils, which gives the patient a certain amount of deformity and facial asymmetry, in addition to discomfort caused by use of maxillary dental prosthesis, if any and nasal obstruction.[4],[10],[11]

Diagnosis of the nasolabial cyst mainly depends on clinical examination. By means of intraoral bi-digital palpation, it presents as a floating puffy swelling of soft consistency, which is associated with puncture and aspiration, which helps to confirm the diagnosis; this fact was also observed in the present study.[12]

The diagnosis of nasolabial cysts is made straightforward by their extraosseous location. The dentoalveolar abscess is the most common differential diagnosis, which can be eliminated easily by testing the vitality of the affected teeth.[7],[13]

The differential diagnosis is made with odontogenic lesions such as canine space abscess, follicular, periodontal and residual cysts and salivary gland neoplasms. Till today, only one case of carcinoma has been reported to have progressed from a nasolabial cyst in literature. Infected nasolabial cysts may be mistaken for furuncle of the nasal vestibule floor; except for this entity, however, the features of infected nasolabial cysts are very specific, and there is little doubt in the diagnosis. Brown-Kelly first described the histopathology of this lesion in 1898. The cyst consists of respiratory epithelium (pseudostratified ciliated cylindrical or stratified ciliated cylindrical epithelium with goblet cells), although squamous metaplasia may occur in infected cysts. Fluid present within the cysts is produced by goblet cells.[14]


  Conclusion Top


Nasolabial cysts are frequently under-diagnosed in their initial stages and end up leading to progressive facial asymmetry with subsequent aesthetic-emotional disparity. It is fundamental for the dentist to be alert with regard to early diagnosis because it is not uncommon for the patient to fail to observe the lesion in the initial stages, as may be observed in the present case. Adequate diagnostic management and the accurate establishment of the attainable differential diagnoses allow in acquiring suitable therapeutic measures for each case. The treatment of choice is complete surgical excision of the lesion. We would like to conclude this present case by giving a message to the clinicians regarding the unusual location of the nasolabial cyst within the upper lip and helping to ease their diagnostic approach.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sahin C. Nasolabial cyst. Case Rep Med 2009;2009:586201.  Back to cited text no. 1
    
2.
Aquilino RN, Bazzo VJ, Faria RJ, Eid NL, Bóscolo FN. Cisto nasolabial: apresentação de um caso e descrição em imagens por TC e RM. Rev Bras Otorrinolaringol 2008;74:467-71.  Back to cited text no. 2
    
3.
Aikawa T, Iida S, Fukuda Y, Nakano Y, Ota Y, Takao K, et al. Nasolabial cyst in a patient with cleft lip and palate. Int J Oral Maxillofac Surg 2008;37:874-6.  Back to cited text no. 3
    
4.
Nixdorf DR, Peters E, Lung KE. Clinical presentation and differential diagnosis of nasolabial cyst. J Can Dent Assoc 2003;69:146-9.  Back to cited text no. 4
    
5.
Precious DS. Chronic nasolabial cyst. J Can Dent Assoc 1987;53:307-8.  Back to cited text no. 5
    
6.
Cohen MA, Hertzanu Y. (1985) Huge growth potential of the nasolabial cyst. Oral Surg 1985;59:441-5.  Back to cited text no. 6
    
7.
Marcoviceanu MP, Metzger MC, Deppe H, Freudenberg N, Kassem A, Pautke C, et al. Report of rare bilateral nasolabial cysts. J Craniomaxillofac Surg 2009;37:83-6.  Back to cited text no. 7
    
8.
El-Din K, el-Hamd AA. Nasolabial cyst: A report of eight cases and a review of the literature. J Laryngol Otol 1999;113:747-9.  Back to cited text no. 8
    
9.
Ben Slama L, Zaghbani A, Hidaya S. Nasolabial cyst. Rev Stomatol Chir Maxillofac 2009;110:338-9.  Back to cited text no. 9
    
10.
Pereira Filho VA, Silva AC, Moraes Md, Moreira RW, Villalba H. Nasolabial cyst: Case report. Braz Dent J 2002;13:212-4.  Back to cited text no. 10
    
11.
Soldatelli MV, Maschmann RA, Wobido FB, Pinto JG, Isolan TM, Hernandez PA, et al.Cisto nasolabial unilateral: relato de caso clínico. Rev Ciênc Méd Biol 2008;7:90-5.  Back to cited text no. 11
    
12.
Felix JA, Ferreira PJ, Correa R, Cantini R, Neto RM, Felix F. Cisto nasolabial bilateral: relato de dois casos e revisão da literatura. Rev Bras Otorrinolaringol 2003;69:279-82.  Back to cited text no. 12
    
13.
Sumer AP, Celenk P, Sumer M, Telcioglu NT, Gunhan O. Nasolabial cyst: Case report with CT and MRI findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e92-4.  Back to cited text no. 13
    
14.
Kuriloff DB. The nasolabial cyst-nasal hamartoma. Otolaryngol Head Neck Surg 1987;96:268-72.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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