Nasopalatine Duct Cyst Research Articles

Successful Treatment of Nasopalatine Duct Cyst After Maxillary Anterior Implant Surgery: A Case Report.

Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded 1 year after maxillary anterior implant placement following periodontally hopeless teeth extraction. The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. Seven years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

Morphological CBCT parameters for an accurate differentiation between nasopalatine duct cyst and the normal nasopalatine canal

BackgroundThe incisive foramen width was a traditional imaging criterion for diagnosing nasopalatine duct (NPD) cysts. Recent CBCT studies demonstrated significant dimensional variations of the nasopalatine canal, which raised questions about the accuracy of this criterion. This study investigated whether nasopalatine canal diameters assessed on CBCT images can accurately differentiate NPD cysts from normal nasopalatine canals.MethodsThe study included 19 patients with NPD cysts (12 (63.2%) males, 7 (36.8%) females, mean age 44.7 ± 13.3), and a control group of 164 patients (72 (43.9%) males, 92 (56.1%) females, mean age 47.25 ± 17.74). CBCT images were retrospectively evaluated. The following nasopalatine canal diameters were measured on reference sagittal, coronal, and axial reformation images: nasal opening anteroposterior (AP) and mediolateral (ML) diameter, oral opening AP (APOO) and ML (MLOO) diameter, nasopalatine canal length, minimum ML (minML) diameter, anterior wall expansion (AWE), nasopalatine canal angle, and the mid-level AP diameter (midAP). All parameters were compared between groups. Discriminant functional analysis (DFA) was applied to detect CBCT parameters that best differentiate the NPD cyst from the normal canal.ResultsPatients with NPD cyst had significantly greater values of APOO (7.06 ± 2.09 vs. 5.61 ± 1.70), MLOO (6.89 ± 2.95 vs. 3.48 ± 1.24), minML (2.88 ± 1.53 vs. 2.25 ± 1.09), AWE (2.15 ± 0.65 vs. 0.41 ± 0.67), and midAP (4.58 ± 1.61 vs. 2.48 ± 0.96). DFA showed MLOO, AWE, and midAP as the most accurate in distinguishing NPD cyst from the normal canal. When combined in the discriminant function equation X = 0.390·MLOO + 1.010·AWE + 0.288·midAP (cut score 1.669), the differentiation can be performed with a sensitivity and specificity of 98.8% and 76.9%, respectively.ConclusionNPD cysts can be accurately distinguished from the normal nasopalatine canal by measuring MLOO, AWE, and midAP diameter on CBCT images.

Reconstruction of Pathology Induced Anterior Maxillary Defect: A Case Report

A cyst is defined as a pathologic cavity lined by epithelium. Nasopalatine duct cysts (NPDC) are of non-odontogenic origin arising from epithelial remnants from two embryonic nasopalatine ducts. These cysts may form anywhere along the ducts’ course, which runs from posterior palatal midline to the soft tissue palatine papilla also known as the incisive papilla. NPDC often develop between the 4th and 5th decades of life with men being affected more than women (2:1 ratio). They are typically asymptomatic but present with palatal swelling in the anterior maxillary region. Larger cysts may create a labial expansion in addition to a midpalate expansion which is usually compressible due to resorption of bone beneath the mucosa. Radiography often shows a well demarcated round or pear-shaped radiolucency superimposed on the incisive canal, tooth displacement or divergence of roots may be observed. This pathology is usually greater than 6mm in size which differentiates it from the incisive canal. Differential diagnoses often include a periapical granuloma or radicular cyst from nonvital central incisors, however a palatal radiolucency and expansion represents a NPDC until proven otherwise. Typical treatment includes enucleation and curettage with low recurrence rates.

Characterization of Histological Overlap Between Surgical Ciliated Cyst, Frontal-Ethmoidal Sinonasal Mucocele and Nasopalatine Duct Cyst

Characterization of Histological Overlap Between Surgical Ciliated Cyst, Frontal-Ethmoidal Sinonasal Mucocele and Nasopalatine Duct Cyst

Assessment of variations in the nasopalatine canal on CBCT: considerations from an anatomical point of view.

The nasopalatine canal (NPC) is one of the most significant anatomical markers in the anterior maxillary region. Its location is quite important, especially for implant placement. Therefore, the purpose of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphology, size, and anatomic variations of the NPC. A total of 150 individual CBCT images were assessed in various sections to evaluate the dimensions, morphology, and extent of the NPC. Reformatted sagittal images were chosen to classify the shape and course of the canal. The Student's t-test, the χ² test, and Pearson correlation coefficients were used. The NPC was longer in males than in females, and the mediolateral diameter of the canal was greater in older adults. In sagittal sections, the canal predominantly exhibits a cylindrical shape, while a spindle shape is the least common. In coronal sections, a single shape is most frequently observed, with a Y-shape being the least common. Regarding the orientation of the canal, slanted canals are more prevalent, whereas vertically curved canals are rare. Typically, 2 canal openings are observed, with 4 openings being the least common. The current study highlights the challenges associated with identifying the anatomical appearance and variations of the NPC. Consequently, possessing a thorough understanding of this anatomy is essential before undertaking any surgical procedures, such as implant placement. This knowledge helps prevent complications such as nerve injury-related loss of sensation, bleeding due to blood vessel injury, and the development of a nasopalatine duct cyst following trauma to the canal during surgery.

A nasopalatine duct cyst in an orthodontic patient: a case report

This case report describes the presentation of a nasopalatine duct cyst in a 27-year-old orthodontic patient. The patient presented with pain in the anterior hard palate and a Class II division 2 occlusion with a complete overbite. The cyst was discovered upon further radiographic investigation. Following discussion at a joint orthognathic clinic, the decision was made to leave the cyst under active monitoring and review the patient clinically and radiographically after 12 months. CPD/Clinical Relevance: Nasopalatine duct cysts are common, therefore awareness of their clinical and radiographic features and treatment options is essential.

A brief insight regarding Nasopalatine duct cyst- Report of two cases with a review of literature

Abstract Nasopalatine duct cysts (NPDCs) are among the most common nonodontogenic cysts, typically located in the midline of anterior maxillary hard palate. They usually arise from the embryonic epithelial vestiges of the nasopalatine duct. NPDCs predominantly affect adult males, generally during their fourth decade of life. Clinically, they present as asymptomatic or occasionally painful, fluctuant or discharging swellings involving the hard palate. Radiographically, NPDCs are characterized by a well-defined, fairly corticated, inverted pear-shaped or heart-shaped radiolucency situated between the roots of the maxillary incisors. Histopathologically, NPDCs exhibit a wide spectrum of findings. The lining may be comprised of stratified squamous, pseudostratified ciliated columnar, columnar, or cuboidal epithelium, or a combination and transition of these types. The cystic capsule is fibrocollagenous and can exhibit certain unique features, such as neurovascular bundles, mucous glands, and cartilaginous rests. NPDCs are typically managed through surgical enucleation, and recurrences are rare. Herein, we present two cases of NPDCs, along with a brief overview of their origin, relevant diagnostic features, and management.

Spread asymmetry to differentiate nasopalatine duct cysts from radicular cysts arising in the anterior maxilla on computed tomographic images.

The aim of this study was to clarify numerical values for differentiating nasopalatine duct cysts (NPDCs) from radicular cysts (RCs) arising in the anterior maxilla on computed tomography (CT) or cone-beam CT (CBCT) images. CT or CBCT images of histologically proven NPDCs (n = 30) and RCs (n = 33) beyond the midline of the maxilla were investigated to determine two asymmetry indices on axial images of the maximum lesion area. The lateral asymmetry index was calculated based on two distances from each of the lateral ends of the lesion to the midsagittal plane. The index was defined as the difference between the two distances divided by their sum. The labio-palatal asymmetry index was determined by the distance between the labial and palatal ends of the lesion and the coronal plane passing through the central incisor root apex. The performance of these indices was assessed by receiver operating characteristic (ROC) analysis. The cutoff values for differentiating NPDCs from RCs were determined with the Youden procedure on the ROC curve. The area under the ROC curve was 0.97 for the lateral asymmetry index and 0.88 for the labio-palatal asymmetry index. The cutoff values for differentiation were 0.36 and 0.68 for the lateral and labio-palatal asymmetry indices, respectively. The lateral asymmetry index appeared to be an effective reference for differentiating NPDCs from RCs on CT or CBCT images. When the index was less than the cutoff value, a diagnosis of NPDC was strongly suggested.

Actinomyces-associated Calcification in a Nasopalatine Cyst

Actinomycosis is a chronic bacterial infection caused by Actinomyces species. Actinomyces are commensals of the human oropharynx and can invade local structures when mucosal integrity is breached. Within an actinomycosis lesion chronically inflamed and necrotic tissue may undergo dystrophic calcification. This case report documents the assessment, diagnosis, and management of Actinomyces-associated calcification within a nasopalatine cyst, a previously unreported situation. CPD/Clinical Relevance: Actinomycosis lesions of the jaws may present with radiographically detectable calcification(s).

Diagnostic spectrum of cysts of head and neck: Case series and review of literature

One of the foremost problems that brings patients to Otorhinolaryngology clinics are cystic swellings in the head and neck region. We aimed to study the presentation, configuration of cystic swellings of head and neck for diagnosis and management. A retrospective study of 30 patients belonging to diverse age group and presenting with complaints of swelling in the craniofacial domain to the otorhinolaryngology outpatient department was conducted. Based on the characterization of cystic swellings of head and neck, most turned out to be usually benign. The most common cyst was epidermoid cyst (56%), followed by second arch branchial cyst (26%). A single case each of nasopalatine cyst and intra-parotid lymphatic cyst was also reported. Swellings in the head and neck can have various presentations. Cytologic examination of head and neck cysts along with pre-operative clinical examination and imaging offer imperative information concerning the nature of the cystic lesions, and may rarely lead to any misdiagnosis.

Performance of a deep learning system for simultaneously diagnosing radiolucent and radiopaque lesions in the anterior maxilla on panoramic radiographs

AbstractAimTo validate the performance of a deep learning system with detection and classification functions for a mix of radiolucent and radiopaque lesions in the anterior maxilla on panoramic radiographs.MethodsPatients with radiolucent or radiopaque lesions in the anterior maxilla on panoramic radiographs were selected retroactively from May 2022 until Feb 2002 to obtain 100 preoperative radiographs each for nasopalatine duct cysts (NDCs), radicular cysts (RCs), and impacted supernumerary teeth (ISTs). An additional 100 patients with no lesions in the anterior maxilla were selected. Two deep learning systems (Systems 1 and 2) were created and tested. For System 1, the models were created and tested using datasets of radiolucent lesions (NDCs and RCs) and No lesions. For developing System 2, the data of radiopaque lesions (ISTs) were added to those used in System 1. The neural network used was You Only Look Once ver. 7 (YOLOv7). The recall, precision, F1 score, and accuracy calculated from the confusion matrix were used to evaluate diagnostic performance.ResultsThe performance of System 2, which included the IST data, was worse than that of System 1. Even when NDCs and RCs were addressed as a joint category of radiolucent lesions, the addition of IST data resulted in a worse performance than that of System 1.ConclusionOur results indicate that combined use of radiopaque lesions (ISTs) with radiolucent lesions (NDCs and RCs) reduces the deep learning performance for radiolucent lesions with the volume of data used in the present study.

Late recurrence of calcifying odontogenic cyst: Report of a rare case and review of the literature

AbstractCalcifying odontogenic cyst (COC) is a relatively uncommon cyst of odontogenic origin, occurring in the second decade of life, with no jaw predilection. Radiographically, it typically appears as a well‐defined unilocular radiolucency containing irregular calcifications of varying size and opacity. Treatment consists of conservative surgical excisions with low recurrence rates. The purpose of this paper is to report a rare case of late COC recurrence and review the pertinent literature. A 42‐year‐old female patient presented for evaluation of a painless swelling in the palate, which had been present for 5 years with a gradual, slow increase in dimensions. Twenty years before, a lesion at the same site was surgically excised with a diagnosis of COC. Clinical examination revealed a hard‐in‐consistency swelling in the anterior segment of the hard palate. Radiographically, a radiopaque lesion with an irregular outline was noticed in the left palate adjacent to the left maxillary canine and first premolar, along with a well‐defined radiolucent lesion between the maxillary central incisors. Both lesions were surgically excised, and histopathological examination revealed that the main lesion in the left palate was consistent with recurrent COC, while the lesion between the central incisors was compatible with a nasopalatine duct cyst. Even though the recurrence rate of COC is low, estimated at 3.4% based on our review of the relevant English‐language literature, the current case highlights the possibility of a late recurrence, even several years after the initial diagnosis and treatment, and therefore the need for long‐term follow‐up.

Nasopalatine Duct Cyst Associated with Non-Vital Teeth: Report of a Rare Case.

The online version contains supplementary material available at 10.1007/s12070-024-04513-1.

Blood Collection for Autologous Blood-Derived Product Preparation: Technique and Application

Background: In periodontics, interest in use of autologous blood-derived products (ABPs) has increased due to demonstrated safety, enhanced initial healing, and for some applications, superior clinical outcomes. Periodontists commonly place peripheral intravenous catheters for moderate sedation, thus encountering opportunities to utilize ABPs routinely. The purpose of this report is to describe a safe blood collection technique for ABP preparation and define typical blood volume requirements for periodontal procedures. Methods: Five cases requiring various amounts of liquid and membrane-formed platelet-rich fibrin are presented. Case 1 involves treatment of an infrabony periodontal defect. Case 2 illustrates alveolar ridge preservation at a maxillary right second premolar site. Case 3 demonstrates repair of a defect related to nasopalatine duct cyst removal. Cases 4 and 5 illustrate the use of PRF in sinus elevation and root coverage, respectively. Results: Use of PRF in the presented cases added minimal procedural time and expense. Blood samples varied from 20 to 60 ml in volume. There were no complications related to blood collection or use of PRF. Each patient reported minimal discomfort limited to the first few postoperative days. Favorable early healing was observed in each case. Conclusions: The blood collection method described in this report, which is consistent with published standards of practice, necessitates few additional steps and supplies for practitioners already placing peripheral intravenous catheters. Blood volumes necessary for typical procedures in periodontics are safe and well below maximum attainable samples.

Coincidence of nasopalatine duct cyst and dentigerous cyst: a rare case report


 
 
 Dentigerous cyst is one of the most common odontogenic cysts of the jaw that slowly grows around an unerupted tooth crown. Nasopalatine duct cyst is a non-odontogenic common jaw cyst. Co-oc- currence of nasopalatine duct cyst and dentigerous cyst in the same location of the same jaw is ex- tremely rare. Odontogenic and non-odontogenic cysts occurring simultaneously in non-syndromic patients is rare. The lesions must be fully extracted by surgery. We report the treatment procedure of a patient suffering from this rare phenomenon.
 
 

Immediate implant placement with nasopalatine duct cyst enucleation: A case report

Immediate implant placement with nasopalatine duct cyst enucleation: A case report

Atypical Neurofibroma Masquerading an Odontogenic Cyst-A Case Report

Neurofibroma is a benign tumor characterized by perineural fibroblast proliferation. It is common in the head and neck region but rare in the oral cavity. Most of these lesions are asymptomatic but sometimes may be associated with pain and paraesthesia. Neurofibromas with atypical features are quite rare and only a few cases are reported in literature. Here is a case of a female patient presented with pain and swelling in the anterior maxilla, which was clinically diagnosed as a periapical cyst. Radiographic evaluation of the lesion revealed dilated incisive canal and a Nasopalatine duct cyst was suspected. The patient was advised to take antibiotics for one week. The symptoms were sustained in the follow-up visit and an incision biopsy was made. Microscopic examination revealed pleomorphic spindled and round cells. Immunohistochemistry was performed to identify the origin of these pleomorphic cells. Based on the histopathological examination, special staining, and immunohistochemistry, we concluded the diagnosis as neurofibroma with atypical features. The current case emphasizes the significance of clinical, radiological, histopathological, and immunohistochemical evaluation of oral lesions. The presence of atypical features in Neurofibroma must be considered cautiously as as it is more prone to progress into Malignant Peripheral Nerve Sheath Tumor (MPNST).

Assessment of the Nasopalatine Canal in Patients Requiring Dental Implants in the Maxillary Anterior Region Using Cone Beam Computed Tomography.

To assess the nasopalatine canal in patients requiring dental implants in the maxillary anterior region using cone beam computed tomography (CBCT). About 56 patients requiring dental implants in the maxillary anterior region of either gender reporting to the daily Outpatient Department, Department of Oral Medicine and Radiology aged between 18 and 60 years were selected. They were subjected to a CBCT scan using Newtom Giano CBCT machine (NewTom, Imola, Italy). Newtom New Technologysoftware and a slice thickness of 0.3 mm were used. For assessment of the implant site at the maxillary anterior region, alveolar bone width in the anterior region of the canal at the upper, middle, and lower third, incisive foramen diameter (IFD), nasopalatine canal length (NPCL), canal diameter in the floor of the nasal fossa and nasopalatine canal morphology was determined. Out of 56 patients, males comprised 30 and females 26. The mean bone height in 11 regions was 15.6±3.9, in 12, 16.2±2.7 mm, in 13 was 15.5±2.4 mm, in 21 was 13.7±4.2 mm, in 22 was 14.7±3.6 mm, in 23 was 16.7±1.5 mm. A non-significant difference was observed when comparing the bone height at different implant sites (p>0.05). The mean bone width at 3 mm and 6 mm from an alveolar crest in 11 regions was 4.3 mm and 5.3 mm, in 12 was 5.7 mm and 6.2 mm, in 13 was 3.7 mm and 4.6 mm, in 21 regions was 4.1 mm and 5.5 mm, in 22 regions was 4.6 mm and 5.7 mm and in 23 regions was 4.0 mm and 4.9 mm, respectively. A significant difference was observed when comparing the bone width at 3 mm and 6 mm at different implant sites (p<0.05).Nasopalatine canal type was A in 42 (75%), B in 13 (23.2%), and C in 1 (1.8%) patient. The mean alveolar bone width in the anterior region of the canal at the upper third was 10.1 mm, in the middle third was 7.4 mm, and in the lower third was 5.2 mm. The mean IFD was 4.6 mm, the NPCL was 13.5 mm, and the canal diameter on the floor of the nasal fossawas 3.8 mm. A significant difference was observed in comparing nasopalatine canal type (p<0.05). For the clinician to assess implant placement in the maxillary esthetic zone, CBCT imaging of the nasopalatine canal is crucial. It is possible to prevent intraoperative and postoperative complications such as hemorrhage, sensory impairment, osseointegration failure, and nasopalatine duct cyst formation.

Mature Cystic Oral Teratoma in a Neonate- A Case Report.

Neonatal oral cavity masses present complex diagnostic and management challenges, often involving respiratory distress. We present a case of a 1-day-old male neonate with an oral cavity mass and respiratory distress, whose antenatal scan revealed polyhydramnios and a nasopalatine cyst. Clinical examination revealed a 5 * 5cm cystic swelling arising from the right hard palate. CT scans confirmed an intraoral cystic lesion with a complete cleft palate and excluded oropharyngeal/neck extension. Aspiration of cystic fluid facilitated surgical excision, leading to a histopathological diagnosis of mature cystic teratoma. Primary closure of the soft palate defect was performed. Histopathological examination revealed it to be mature cystic teratoma. This case underscores the intricate interplay between antenatal imaging, clinical assessment, and surgical intervention in managing neonatal oral cavity masses. The successful excision and histopathological confirmation of a mature cystic teratoma highlights the significance of accurate diagnosis and timely intervention. The complexities surrounding neonatal oral cavity masses necessitate a comprehensive approach to optimize patient outcomes.

Clinicoradiopathologic Analysis of Odontomas: A Retrospective Study of 242 Cases.

Odontomas are considered hamartomatous lesions and are one of the two most common odontogenic tumors of the jaw. Odontomas are classified as compound or complex. Recently, ameloblastic fibro-odontoma (AFO) and ameloblastic fibro-dentinoma were reclassified as developing odontomas. Though clinically odontomas are usually asymptomatic, they have adverse effects on adjacent teeth such as tooth impaction, delayed eruption, displacement of teeth, over-retention of teeth, and can give rise to odontogenic cysts within the jaw. We sought to evaluate the clinicoradiopathologic presentations of odontomas by collecting and analyzing the clinical, radiographic, and pathologic data of odontomas diagnosed in our institution from 2013 to 2022. Over this 10-year period, there were 242 patients with a histopathological and/or radiographic diagnosis of odontoma. There was no gender predilection and ages ranged from 3 to 101 years (median, 14 years). The second decade of life was the most prevalent (57.4%). There was no jaw predilection; however, the anterior jaw was the most common location. Ninety-four (38.8%) cases presented with clinical findings. The most common finding was tooth impaction (n = 83). Nine (3.7%) cases were histopathologically confirmed to be associated with other lesions such as dentigerous cysts (n = 8) and nasopalatine duct cyst (n = 1). The median age (25 years) of patients diagnosed with odontomas associated with cysts was older than patients with odontomas (14 years) without associated cysts. Compound odontomas were the most common type of odontoma compared to complex and AFOs with 71.4%, 26.6%, and 2%, respectively. The majority of compound odontomas involved the anterior jaw (69.3%) and mandible (54.9%) while the majority of complex odontomas involved the posterior jaw (59.6%) and maxilla (54.7%). The four AFOs were in the posterior jaw and 75% involved the maxilla. The median age (12 years) of patients diagnosed with AFO was the youngest compared to patients diagnosed with compound (13 years) and complex (16 years). In conclusion, we analyzed the clinical, radiographic, and pathologic features of 242 new cases of odontomas. Our study reaffirms that odontomas frequently affect the pediatric population and can disrupt their dentition. Based on the result of this study, our clinical recommendation to prevent problems to adjacent teeth from odontomas is for dentists to be apt in the diagnose of odontomas to ensure that they are surgically removed in a timely manner.