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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 32-34

Bilateral nasolabial cyst


Department of ENT, ESIC Model Hospital, Beltola, Guwahati, Assam, India

Date of Submission25-Jan-2020
Date of Acceptance18-Jan-2021
Date of Web Publication03-Jul-2021

Correspondence Address:
Dr. Soumick Ranjan Sahoo
T9B Protech Park Hengrabari, Guwahati - 781 036, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aiao.aiao_1_20

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  Abstract 


Nasolabial cyst is an uncommon nonodontogenic extraosseous cyst. Bilateral cysts are rare, and very few are reported in literature. They present as slow-growing swellings in the nasolabial region causing cosmetic deformity and nasal obstruction. We report a rare case of a 59-years-old female who was diagnosed as bilateral nasolabial cyst based on clinical and computed tomography scan findings and underwent excision by sublabial approach. Histopathological examination confirmed the diagnosis.

Keywords: Bilateral, Klestadt's cyst, nasolabial cyst, nonodontogenic


How to cite this article:
Sahoo SR, Sarma M. Bilateral nasolabial cyst. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2021;5:32-4

How to cite this URL:
Sahoo SR, Sarma M. Bilateral nasolabial cyst. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2021 Nov 29];5:32-4. Available from: https://www.aiaohns.in/text.asp?2021/5/1/32/320567




  Introduction Top


Nasolabial cysts are rare nonodontogenic cysts characterized by their extraosseous appearance and located near to ala nasi. They are thought to arise from dormant epithelial tissue triggered by trauma or infection into a cystic structure. It is usually unilateral in occurrence and bilateral nasolabial cyst is rare The incidence of bilaterality is 10%–11%.[1],[2] It usually presents with swelling adjacent to nose. It might extend into nasal cavity or oral cavity. Clinical diagnosis complimented by computed tomography (CT) scan. Surgical excision is the treatment of choice, and recurrence is rare. We present a rare case of bilateral nasolabial cyst in a female.


  Case Report Top


A 59-year-old female presents with swelling in the right cheek and left cheek appreciated for 3 months which was initially small but progressed in size and was associated with right nasal blockage. On examination, there was swelling over right cheek causing obliteration of the right nasolabial fold and another swelling over left cheek causing obliteration of the left nasolabial fold. Anterior rhinoscopy revealed a nontender mucosa covered cystic swelling in floor of the right nasal cavity. On oral examination, there was fullness on the right and left canine fossa. CT scan of nose and paranasal sinus was done along with other preoperative investigations and preanesthetic checkup. CT scan showed a well-defined hyperdense rounded lesion about 20 mm × 18 mm in right nasolabial fold causing molding of underlying maxillary alveolar border and another similar rounded lesion about 11 mm × 14 mm in left nasolabial fold causing molding of underlying maxillary alveolar fold [Figure 1]. A provisional diagnosis of bilateral nasolabial cyst was made. The patient was posted in operation theatre, and nasolabial cysts were excised by sublabial approach under general anesthesia [Figure 2] and [Figure 3]. The diagnosis of nasolabial cyst was confirmed by histopathological examination [Figure 4]. The patient was followed up and no recurrence has been noted.
Figure 1: Computed tomography scan nose and paranasal sinus

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Figure 2: Right nasolabial cyst excision operative picture

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Figure 3: Left nasolabial cyst excision operative picture

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Figure 4: Histopathology picture

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  Discussion Top


Nasolabial cyst, also called as the nasoalveolar cyst or Klestadt's cyst, is a relatively uncommon benign, nonodontogenic, extraosseous maxillary cyst.[3] The cyst is classically related to the nasolabial fold or nasal alar soft tissue. Two popular theories that address its origin include the possible development from the nasolacrimal duct embryologic remnants and from the trapped epithelium at the fusion of maxillary, medial nasal, and lateral nasal process.

Although these cysts are referred to as developmental cysts, the mean age of occurrence is in the adult group, averaging 30–45 years, with female preponderance.[3]

Roed-Petersen reported that, among 116 patients with nasoalveolar cysts, 13 showed bilateral cysts.[4] Vasconcelos et al. reported that bilateral occurrence accounts for 6.6% cases of cysts.[5] Patil et al. reported a case of bilateral nasolabial cyst.[6] Sato et al. also reported a case of bilateral nasolabial cyst.[7]

Clinically, patients present with an asymptomatic slow-growing soft-tissue swelling in the lateral aspect of the nasal ala, typically obliterating the nasolabial fold. The swelling is usually painless unless there is secondary hemorrhage or infection. Spontaneous rupture of the cyst into the nasal cavity resulting in transient discharge and complete resolution can occur. In some cases, recurrence is noted.

On ultrasound, these lesions are anechoic with or without internal debris representing hemorrhage, secretions, or calcium. On CT, the cyst usually shows hyperdense contents but can appear hypodense also. One case report demonstrated calcium levels resembling “milk of calcium” as in renal cysts or in gallbladder.[8] Underlying bone can show smooth bone scalloping in most of the cases due to chronic pressure effect.

Grossly, when resected in toto, the nasolabial cysts are soft-to-firm soft-tissue mass with a smooth surface. Contents are variably cystic with clear fluid, hemorrhage, or purulent material if infected. The epithelium is bilayered or multilayered. The most common type of epithelium encountered is pseudostratified columnar, followed by combined columnar, cuboidal, and columnar, and stratified squamous epithelium. The cyst wall stroma is a hypocellular, collagen-rich fibrovascular tissue with or without chronic inflammatory cells.

Surgery is primarily done for cosmetic reasons and for anticipated secondary complications such as infection or hemorrhage. Open surgical or endoscopic technique is used. Su et al. described transnasal endoscopic marsupialization of the cyst. It is less invasive and easier to perform in large lesions.[9] Open technique involves complete surgical enucleation of the cyst including the cyst wall using sublabial approach to avoid possible recurrences. Other treatment options including sclerotherapy or incision drainage usually lead to local recurrence and are performed in surgically unfit individual.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandrasekharan R, Varghese AM, Mathew J, Ashish G. A rare case of bilateral nasolabial cysts in a postpartum lady. Indian J Dent Res 2014;25:225-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Enoki AM, Pizarro GU, Morais MS, Fernandes DP, Oliveria PR. Nasolabial bilateral cyst as cause of the nasal obstruction: Case report and literature review. Int Arch Otorhinolaryngol 2012;16:121-5.  Back to cited text no. 2
    
3.
Aquilino RN, Bazzo VJ, Faria RJ, Eid NL, Bóscolo FN. Nasolabial cyst: Presentation of a clinical case with CT and MRI images. Braz J Otorhinolaryngol 2008;74:467-71.  Back to cited text no. 3
    
4.
Roed-Petersen B. Nasolabial cysts. A presentation of five patients with a review of the literature. Br J Oral Surg 1969;7:84-95.  Back to cited text no. 4
    
5.
Vasconcelos RF, Souza PE, Mesquita RA. Retrospective analysis of 15 cases of nasolabial cyst. Quintessence Int 1999;30:629-32.  Back to cited text no. 5
    
6.
Patil AR, Singh AP, Nandikoor S, Meganathan P. Bilateral nasolabial cysts-case report and review of literature. Indian J Radiol Imaging 2016;26:241-4.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Sato M, Morita K, Kabasawa Y, Harada H. Bilateral nasolabial cysts: A case report. J Med Case Rep 2016;10:246.  Back to cited text no. 7
    
8.
Yerli H, Cabbarpur C, Aydin E. CT findings of a nasoalveolar cyst. Br J Radiol 2009;82:e76-8.  Back to cited text no. 8
    
9.
Su CY, Chien CY, Hwang CF. A new transnasal approach to endoscopic marsupialization of the nasolabial cyst. Laryngoscope 1999;109:1116-8.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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