|Year : 2015 | Volume
| Issue : 2 | Page : 117-119
Nasopalatine duct cyst: A case report
Saikrishna Pasupuleti1, Nadeem Jeddy2, Makeshraj Loganathan Sambandamoorthy1, Kavitha Seeralan1, Ananthalakshmi Ramamurthy2, Shankar Kolappan Arumugam1
1 Department of Oral Pathology, Tagore Dental College and Hospital, Chennai, India
2 Department of Oral Pathology, Thai Moogambigai Dental College and Hospital, Chennai, India
|Date of Web Publication||12-Jun-2015|
Dr. Ananthalakshmi Ramamurthy
Department of Oral Pathology, Thai Moogambigai Dental College and Hospital, Chennai
Source of Support: None, Conflict of Interest: None
Nasopalatine duct cyst (NPDC) is the most common non-odontogenic cyst of oral cavity. Clinically, Nasopalatine duct cyst manifests as an asymptomatic swelling of the palate or the upper lip. Radiographically, it is seen as a heart-shaped radiolucency and can be confused with periapical pathology. The aim of this article is to report a case of a nasopalatine duct cyst in a 36-year-old patient which was misinterpreted for a periapical cyst. Diagnosis of a Nasopalatine duct cyst can be given through clinical, radiographical, and histopathological examination.
Keywords: Incisive canal cyst, nasopalatine duct cyst, periapical cyst
|How to cite this article:|
Pasupuleti S, Jeddy N, Sambandamoorthy ML, Seeralan K, Ramamurthy A, Arumugam SK. Nasopalatine duct cyst: A case report. J NTR Univ Health Sci 2015;4:117-9
|How to cite this URL:|
Pasupuleti S, Jeddy N, Sambandamoorthy ML, Seeralan K, Ramamurthy A, Arumugam SK. Nasopalatine duct cyst: A case report. J NTR Univ Health Sci [serial online] 2015 [cited 2019 Mar 18];4:117-9. Available from: http://www.jdrntruhs.org/text.asp?2015/4/2/117/158590
| Introduction|| |
The nasopalatine duct cyst (NPDC) is a developmental cyst derived from proliferation of embryonic epithelial remnants of the nasopalatine duct, first described by Meyer in 1914.  Earlier it was regarded as a fissural cyst and now has been categorized under developmental epithelial non-odontogenic cyst of maxillae.  This cyst is considered as the most common non-odontogenic cyst of the oral cavity, which constitutes 73% of all non-odontogenic cysts and 11.6% of jaw cysts in the maxillofacial region. ,
NPDC has male predilection (3:1) and presents as an asymptomatic radiolucency in the maxillary anterior region usually identified in routine radiographic examination. , Rarely, it clinically manifests as itching, ulceration, local infection, and fistulization due to secondary inflammation. Radiologically, a well-demarcated cystic structure appearing as a round, ovoid or heart-shaped radiolucency is seen in relation to the apex of the maxillary central incisors. 
NPDC is usually confused with central giant cell granuloma, and periapical cyst associated with the upper central incisor and supernumerary tooth follicular cyst (usually mesiodens).  We, hereby, document a case of a nasopalatine duct cyst, which was confused for a periapical cyst.
| Case Report|| |
A 36-year-old male patient came to our institution with a complaint of a swelling of size 2 × 3 cm in the upper front teeth region for the past 1 month. Swelling was tender on palpation with poorly defined margins. Tooth number 11 and 21 were mobile and tender on palpation. Occlusal radiograph revealed ill-defined heart-shaped radiolucency [Figure 1]. Intra Oral Periapical radiograph (IOPA R) in relation to 11 and 21 showed no evidence of dental caries and root resorption. Cyst was enucleated and 11, 12, and 21 were extracted. The specimen was sent for histopathological examination.
|Figure 1: Maxillary Occlusal Radiograph showing heart shaped radiolucency|
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Histopathologically, a non-keratinized stratified squamous cystic epithelium of variable thickness overlying a dense connective tissue capsule was seen [Figure 2] and [Figure 3]. The capsule showed areas of hemorrhage and arterioles with intermixed chronic inflammatory cell infiltrate [Figure 4]. Correlating with the clinical, radiographical, and histopathological findings, diagnosis of a NPDC was arrived.
|Figure 2: Cystic cavity lined by epithelium surrounded by connective tissue capsule|
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|Figure 3: Higher magnification shows stratified squamous nonkeratinized epithelium of variable thickness|
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|Figure 4: Muscular arteriole seen in the cyst wall with scattered chronic inflammatory and areas of hemorrhage|
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| Discussion|| |
The nasopalatine duct forms a communication between the nasal cavity and the anterior palate through the nasopalatine foramen. The contents of the nasopalatine canal are nasopalatine duct, nasopalatine nerve plus anastomosing branches of descending palatine and sphenopalatine arteries. Though there are usually two canals, there can be as many as six different foramina with independent neurovascular bundles. The foramina consisting exclusively nerve elements are named Scarpa's foramina.  In lower mammals, nasopalatine canal contains an auxiliary olfactory organ, called Jacobson's organ or vomero nasal organ appearing at 12 th week and undergoing invagination at 15 th week of fetal life.
The NPDC is a developmental cyst derived from the proliferation of embryonic epithelial remnants of the nasopalatine duct.  It was considered as a fissural cyst in the past, at present these lesions are regarded as developmental, epithelial, and non-odontogenic cyst of the maxillae. They are otherwise termed as anterior middle cyst, maxillary midline cyst, anterior middle palatine cyst or incisor duct cyst. 
On radiographic examination, it appears as a round, ovoid or typical heart-shaped radiolucency. This type of heart-shaped radiolucency occurs due to superimposition of the nasal spine. This cyst can cause divergence of the root of anterior tooth but the lamina dura of these teeth remains intact. 
NPDC is usually confused radiographically with central giant cell granuloma, periapical cyst, and follicular cyst arising from supernumerary teeth (usually mesiodens). Since the radiolucent area of the NPDC is often seen near apices of the central incisors, it could be most probably confused with periapical lesions. A positive response to pulp vitality test in these teeth may suggest that the cyst is a non-endodontic in origin.  It is difficult to establish an accurate diagnosis clinically when teeth have undergone endodontic treatment.
In the present case, the lesion was confused with periapical lesion radiographically and the teeth were unnecessarily extracted. Pulp vitality test in this patient could have prevented the teeth from extraction, since enucleation or marsupilization is the treatment of the nasopalatine duct cyst.  The recurrence rate in these cysts is low and cystic cavity usually shows bone regeneration after surgery, the treatment could have been only enucleation and marsupialization with splinting rather than extracting the teeth.
| Conclusion|| |
Proper clinical, radiographical examination with pulp vitality test has to be utilized before starting treatment for any radiolucent lesion in the maxillary anterior teeth. In our case, pulp testing prior to treatment could have saved the tooth from extraction.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]