Giant cyst of the incisive papilla – Largest ever reported

Abstract

<h3>Introduction</h3> Fewer than 5 cysts of the incisive (nasopalatine) papilla have been reported, none has alter underlying bone and none was larger than <0.6 cm. <h3>Objective</h3> To report the largest incisive papilla cyst, with partial bony involvement. Clinical/radiographic findings: A 47 year old woman presented with a 1.8 cm., tender, sessile midline mass posterior to her central incisors; it was moderately firm, not bony hard. Periapical radiographs revealed a rounded, well-demarcated radiolucency of the maxillary midline, with a sclerotic rimming of much of its border. Cone beam CT imaging confirmed the well-demarcated radiolucency and further demonstrated a thick soft tissue lining around an apparently fluid-filled, much darker radiolucent center. The lesion lacked a palatal cortex and had pushed upwards, expanding inferior portions of the overlying nasopalatine duct, providing a shape similar to an inverted chalice. CBCT clearly showed a direct connection with the duct, which extended to the nasal sinuses and showed thickened sinus membranes at each superior opening, suggesting sinusitis. Microscopic findings: At surgery the mass was cystic, filled with a clear fluid. Microscopically, the cystic space was lined by an epithelium that combined the appearance of squamous, cuboidal and respiratory epithelium. This covered a dense fibrous stroma with focal areas of chronic inflammatory cells and congestion. The stroma also contained a large artery, several large veins, a large nerve, and a mucous gland. There was no bone separating the cyst from the palatal mucosa. Follow-up. During a follow-up visit at 10 days post-surgery, the area was healing well and there was no paresthesia of the anterior palate. <h3>Conclusion</h3> We report the largest cyst of the incisive papillae, 1.8 cm. in diameter. It had expanded into the overlying nasopalatine duct.