Mandible & maxilla
Cysts of the jaw
Nasopalatine duct cyst
Author: Kelly Magliocca, D.D.S., M.P.H.
Editorial Board Members: Elizabeth Ann Bilodeau, D.M.D., M.D., M.S.Ed., Marc Pusztaszeri, M.D.
Last author update: 29 August 2024
Last staff update: 29 August 2024
Copyright: 2004-2024, PathologyOutlines.com, Inc.
PubMed Search: Nasopalatine duct cyst
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Gross images | Frozen section description | Frozen section images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Videos | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Magliocca K. Nasopalatine duct cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillanasopalatine.html. Accessed December 3rd, 2024.
Definition / general
- Nasopalatine duct cyst is a nonodontogenic developmental cyst that arises in maxillary bone within the incisive canal (Clin Oral Investig 2015;19:1611)
Essential features
- Developmental cyst, nonodontogenic
- Epicenter within the incisive canal; can involve the right or left maxilla as it enlarges
- Cyst lining is nonkeratinized squamous or respiratory epithelium
- Neurovascular bundle may or may not be identified within the cyst wall
Terminology
- Incisive canal cyst
ICD coding
- ICD-10: K09.1 - developmental (nonodontogenic) cysts of oral region
Epidemiology
- Is the most common nonodontogenic cyst within the jaws (Oral Surg Oral Med Oral Pathol 1994;77:276, J Oral Pathol Med 2006;35:392)
- Occurs most frequently in patients aged 30 - 60 years (J Craniomaxillofac Surg 2018;46:264)
- M:F = ~3:1 (J Craniomaxillofac Surg 2018;46:264)
Sites
- Exclusively in maxilla
- Most commonly located in anterior hard palate, usually midline (Clin Oral Investig 2015;19:1611)
Pathophysiology
- Trauma, inflammation and infection may stimulate proliferation of the epithelial remnants in the nasopalatine canal and may represent etiologic factors in a subset of cases (Med Oral Patol Oral Cir Bucal 2008;13:E438, Clin Oral Investig 2015;19:1611)
Etiology
- Developmental cyst, nonodontogenic
- Arises from respiratory and squamous epithelial vestigial remnants of an embryonic nasopalatine duct (Anat Rec (Hoboken) 2017;300:1093)
Clinical features
- Presents as sessile swelling posterior to the maxillary incisors or entirely asymptomatic
- May present as a swelling on the labial alveolus or bulging into the nasal floor (Oral Implantol (Rome) 2012;5:47, J Craniomaxillofac Surg 2018;46:264)
- Lesion is often 1 - 2 cm in size but may reach several centimeters (J Oral Maxillofac Surg 1991;49:268, Med Oral Patol Oral Cir Bucal 2008;13:E438)
Diagnosis
- Diagnosis is dependent on clinical, radiologic and pathologic correlation including
- Epicenter within the incisive canal
- Cyst lining of nonkeratinized squamous or respiratory epithelium
- Neurovascular elements or benign cartilage may or may not be identified within the cyst wall
Radiology description
- Well circumscribed, corticated, symmetrical rounded or heart shaped radiolucency within the anterior maxilla
- Radiographic superimposition of the anterior nasal spine often produces a characteristic heart or pear shaped radiolucency
- Cyst is often located between the roots of central incisors and may cause displacement
- Adjacent teeth are vital with intact lamina dura
- In general, the cyst is typically > 6 mm (i.e., larger than the generally accepted diameter of the normal incisive canal) (J Oral Maxillofac Surg 1991;49:268)
Radiology images
Images hosted on other servers:
Axial CT scan
Occlusal plain film
Panoramic radiograph
Expansile maxillary alveolus
Well defined round radiolucent area
Homogeneous high intensity area
Sagittal / axial CT images
Prognostic factors
- Recurrence is unexpected after complete treatment (Indian J Otolaryngol Head Neck Surg 2013;65:385)
Case reports
- 31 year old man with small nasopalatine duct cyst (J Dent Sci 2021;16:1047)
- 43 year old man with nasopalatine duct cyst masquerading as a periapical cyst (Int J Appl Basic Med Res 2024;14:60)
- 45 year old man with nasopalatine duct cyst in association with dental implant (J Oral Maxillofac Pathol 2013;17:319)
Treatment
- Surgical excision (open or endoscopically) is most common but marsupialization may also been performed (J Oral Maxillofac Surg 1991;49:268)
Clinical images
Images hosted on other servers:
Preoperative appearance
Intraoperative view, cystic area
Gross description
- Sectioning reveals cystic and fibrous areas
Gross images
Images hosted on other servers:
Enucleated specimen
Frozen section description
Frozen section images
Microscopic (histologic) description
- Cyst epithelium
- Often lined by > 1 type of epithelium and intermediate appearances are often seen (J Oral Maxillofac Surg 1991;49:268, J Craniomaxillofac Surg 2018;46:264)
- Nonkeratinizing stratified squamous epithelium
- Pseudostratified columnar epithelium (variable cilia and goblet cells)
- Bilaminar cuboidal epithelium
- Subepithelial hyalinization may occur
- Cyst wall may feature
- Dense fibrous tissue with nerves, cartilaginous rests, vascular channels
- Lobules of mucous or seromucinous glands
- Inflammation and cholesterol clefts may be present
- Incidental trabeculae of bone (incorporated during surgical excision)
Microscopic (histologic) images
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Cyst fragments
Nerve and mucinous glands
Bilaminar cuboidal
Cyst contents
Intermediate appearances
Respiratory epithelium
Subepithelial hyalinization
Squamoid lining
Virtual slides
Images hosted on other servers:
Fragmented cyst
Videos
Cysts of the jaws part 4: miscellaneous cysts
Sample pathology report
- Anterior maxilla, excision:
- Nasopalatine duct cyst
Differential diagnosis
- Glandular odontogenic cyst:
- Intraosseous developmental odontogenic cyst; may have ciliated or mucous cells within cystic lining
- Nasolabial (nasoalveolar) cyst:
- Soft tissue (nonintraosseous) cyst with histologic features that can resemble nasopalatine duct cyst
- Occurs in soft tissues of upper lip lateral to midline
- Should not have contents of incisive foramen (peripheral nerve, cartilaginous rests, muscular vascular channels)
- Periapical (radicular) cyst:
- Most common inflammatory odontogenic cyst
- Lined by stratified squamous epithelium of variable thickness, often with scattered ciliated cells
- Derived from rests of Malassez
- Surgical ciliated cyst:
- Cyst occurring many years after a surgical procedure involving maxillary sinus or nasal cavity
- Cystic expansion of respiratory epithelium within maxilla; may have ciliated or mucous cells within cystic lining
- Usually located in posterior maxilla and lacks contents of incisive foramen
Additional references
Board review style question #1
Which of the following statements best describes a nasopalatine duct cyst?
- Benign cyst arising from remnants of the nasopalatine duct
- Benign cystic neoplasm arising within the nasopalatine canal
- Commonly occurs in the mandible
- Typically filled with purulent material
Board review style answer #1
A. Benign cyst arising from remnants of the nasopalatine duct is the correct answer because the cyst is a developmental nonodontogenic cyst that arises from the remnants of the nasopalatine duct. Answer B is incorrect because nasopalatine duct is not a neoplasm. Answer C is incorrect because nasopalatine duct cyst exclusively occurs in the maxilla. Answer D is incorrect because nasopalatine duct cyst is not typically associated with acute inflammation.
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Board review style question #2
What is the most common clinical presentation of a nasopalatine duct cyst?
- Asymptomatic swelling of the anterior palate
- Numbness and tingling of the lower lip
- Painful swelling in the mandibular region
- Ulceration and bleeding of the gingiva
Board review style answer #2
A. Asymptomatic swelling of the anterior palate is the correct answer because nasopalatine duct cyst tends to slowly expand the region of the anterior palate as the cyst enlarges. Answer C is incorrect because nasopalatine duct cyst does not occur in the mandible. Answer B is incorrect because nasopalatine duct cyst does not occur near nerves that would lead to numbness and tingling in the lower lip. Answer D is incorrect because nasopalatine duct cyst tends to enlarge slowly over time with little resulting ulceration or bleeding of surrounding structures.
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