06 February 2022

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Nasopalatine Duct Cyst: case report and diagnostic considerations

Authors: Nadim Oliva, Giuseppe Di Martino, Dario Scarnò, Federico Guerri, Pietro Fusari:

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Cysts are composed of an inner epithelial portion containing a liquid secretion and of an outer connective wall. In 2017, the last World Health Organization (WHO) classification of odontogenic and maxillofacial bone tumors was published. Odontogenic and non-odontogenic cysts were classified in two main groups: (1) odontogenic cysts of inflammatory origin; (2) odontogenic and non-odontogenic developmental cysts. In particular, nasopalatine duct cyst (NDC) is included among non-odontogenic developmental cysts and it is the most common cyst in this group. This article describes a case report of NDC treated in our department concerning the most up to date clinical and epidemiological features.

Materials and methods

During April 2019, a 45 years patient was surgically treated for a nasopalatine duct cyst (NDC) of 2,3 cm. Clinical exam showed a palatal swelling elastic in consistency. Nevertheless, the patient was asymptomatic. All the four superior incisors were assessed through dental pulp test and the response was positive. Diagnostic hypothesis of nasopalatine duct cyst was formulated after having analyzed carefully both the first-level (orthopantomography) and the second-level (cone beam computed tomography) radiological exams. Then, surgical removal of the cyst was planned and these following steps were performed: local infiltration anesthesia, intrasulcular incision, full-thickness flap, mucoperiosteum detachment, access to the surgical site with straight handpiece and carbide bur, removal of the cyst and alveolar curettage. In conclusion, a primary healing was achieved performing simple interrupted stitches using a 4/0 polyglycolic acid suture. The patient was discharged after having provided him post-operative instructions and pharmacological therapy. In particular, antiseptic mouth rinse and anti-inflammatory drugs were prescribed. The sample was sent to anatomy pathology department to confirm the diagnosis. Clinical and radiological follow-up were at 1, 3, 6 and 12.


Results

Histopathological examination confirmed the diagnosis of NDC. Macroscopically, the biopsy specimen appeared as a thin grey lesion. With a maximum dimension (diameter) of 2,3 cm. From the microscopic point of view, the examinated sample was characterized by a paucistratified architecture formed by cubic cells, some with “terminal plate” structure. Clinical and radiographic follow-up showed an increasing and full regeneration of both soft and hard tissues. Neither intra-operatory nor post-operatory complications were detected.

Conclusions 

In conclusion, surgical removal of NDC is the gold standard treatment. The literature reported a recurrence rate that ranged from 0% to 11%. It can’t be made NDC diagnosis without histopathological examination.

Clinical significance

Although nasopalatine duct cyst is characterized by a low incidence, it is one of the most common developmental cysts. Therefore, the knowledge of diagnostic features and gold standard treatment allows clinicians to treat it correctly.