Year : 2021 Month : December Volume : 10 Issue : 45 Page : 4044-4046,

Nasoalveolar Cyst - A Case Report

Anita D. Munde1, Sunil S. Mishra2, Sneha Patil3, Pooja B. Nayak4, Anwesha S. Samanta5

1, 4, 5 Department of Oral Medicine and Radiology, Rural Dental College, Pravara Institute of Medical Sciences, (Deemed University) Loni, Maharashtra, India.
2 Department of Oral Medicine and Radiology, Dr. D.Y. Patil Dental College and Hospial, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India.
3 Department of Oral Medicine and Radiology, SMBT Institute of Dental Sciences and Research, Dhamangaon, Nashik, Maharashtra, India.


Dr. Anita Munde, Department of Oral Medicine and Radiology, Rural Dental College, Pravara Institute of Medical Sciences, (Deemed University) Loni, Maharashtra, India.
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Klestadt’s cyst is a rare, benign, developmental, non-odontogenic soft-tissue cyst of the nasoalar region of the midface.1 It is also known as ‘‘nasolabial cyst’’ or ‘‘nasoalveolar cyst’’ (NC). It is uncommon, affecting 1.6 per 100000 persons each year, more frequently in females in the fourth and fifth decades of life. Characteristic clinical manifestations include slowly enlarging asymptomatic swelling in the nasolabial region, mostly without radiographic abnormalities. Medical advice is usually sought on secondary infection of the cyst or due to the disfigurement caused by it.2 This paper documents the clinicoradiological presentation and management of a nasolabial cyst in a 48-year-old woman and discusses the differential diagnosis of this rare entity.


A 48-year-old woman reported to the dental OPD with a presenting complaint of painless swelling associated with the right ala of the nose and subsequent facial asymmetry. History of present illness revealed the duration of the swelling roughly since a year that was slowly growing. Extraoral examination revealed a diffuse swelling evident at the right nasal alar region with obliteration of the right nasolabial sulcus (Fig. 1). The overlying skin was normal in colour. Intranasal examination showed a partial obliteration of the anterior nasal vestibule on the right side. Intraorally, on inspection there was no evidence of swelling however, its presence was confirmed on palpation in the deep labial vestibule in the maxillary right incisor and canine region. The overlying mucosa was intact and normal in colour. The lesion, measuring 3×2 cm in size, was soft in consistency and non-tender on palpation. The associated teeth in the maxillary anterior region did not show evidence of caries, discolouration or other pathology, and were tested vital on electric pulp testing. Radiographic examination including panoramic and intraoral periapical views of the associated dentoalveolar region revealed normal bony architecture (Fig. 2). Fine needle aspiration was advised but the patient refused the same.


After taking into consideration the history and clinical presentation a working diagnosis of the nasolabial cyst was given.


Dermoid/epidermoid cyst and benign soft tissue neoplasms were considered as differential diagnoses.



CT scan showed a well-defined round to oval homogenous soft tissue density lesion measuring 1.9 x 2.2 x 2.2 cms (AP x TR x CC) in the right nasolabial region. A post-contrast study showed peripheral enhancement.

Anterolaterally it was causing bulge over the skin, medially obliteration of nasal cavity and posteriorly it was causing scalloping of the maxilla. The nasal septum and hard palate appeared normal. (Fig. 3) Findings were suggestive of NC.

The lesion was enucleated through a transoral sublabial approach.


Under the microscope, the tissue section showed pseudostratified columnar epithelium and the stratified squamous epithelium lining the cystic cavity with fibrous connective tissue and chronic inflammatory cells, suggestive of NC.


Based on the clinical, radiographic, and histopathological findings a final diagnosis of NC was confirmed and surgical management was recommended. The postoperative follow-up course after one year was uneventful with norecurrence.




A nasolabial cyst is a developmental, non-odontogenic type of soft tissue cyst. It has been known by synonyms such as Nasovestibular cyst, Nasoglobular cyst, Nasoalveolar cyst, Mucoid cyst of the nose, and Nasal wing cyst since its original description by Zukerkandl in 1882.3 Although Thoma suggested the term nasoalveolar cyst, it was Rao in 1951 to use the term nasolabial cyst. Klestadt (1953) studied the lesion in detail after which it was named Klestadt’s cyst.4

NC is a rare lesion that accounts for 0.7 % of all the cysts and 2.5 % of all non-odontogenic cysts in the maxillofacial region. However, many authors believe that its prevalence is higher than documented in the literature due to misdiagnosis. It is more commonly seen in African-American adults in their fourth and fifth decades of life with greater incidence in females (4:1 ratio). Usually unilateral, it has no predilection for the side. Regardless of this, 11.2 % of cases have been reported to be bilateral.5 In a systematic review of 311 cases by Sheikh, AB, NC had occurred with 46.9 %, 37.5 %, and 10.9 % on the left side, right side, and bilateral, respectively.6

Pathogenesis of NC is controversial but mostly believed to derive from remnants of the nasolacrimal duct or develop as inclusion cysts of mesenchymal cells during the fusion of lateral and medial nasal prominences to the maxillary prominence during the formation of facial skeletal.7

The common clinical features include slowly growing, painless mass adjacent to the nose resulting in obliteration of nasolabial sulcus, nasal vestibule, and maxillary labial sulcus. Distention of the muco-labial sulcus intraorally can cause discomfort in denture users. NC is usually asymptomatic unless it is secondarily infected which causes pain.


The most common presenting complaints are related to cosmetic reasons or nasal blockage. On palpation, the lesion is soft and fluctuant in consistency. Our patient who was 48 years female and reported due to painless swelling resulting in noticeable nasal asymmetry / deformity.

The teeth in the area of the lesion are vital unless affected by a pathosis unrelated to the cyst. Sometimes the cyst may rupture spontaneously and drain into the oral cavity or nose or, occasionally, via a cutaneous fistula.4 In the present case, there was no dental foci of infection and the teeth were vital.

In the differential diagnosis of NC, other odontogenic and non-odontogenic lesions, that can occur in the anterior maxilla or soft tissues of the nasolabial region should be considered. Periapical pathologies like abscess, granuloma, and cyst arising from maxillary anterior teeth, could perforate the bone and extend into adjacent soft tissues to simulate the NC. A nonvital tooth and the presence of periapical radiolucency involving the teeth can rule out these diagnoses. Nasopalatine duct cyst is an intraosseous cyst found in the anterior mid palatine region whereas NC is exclusively found in soft tissues. Other odontogenic cysts such as dentigerous cysts, odontogenic keratocyst which can also perforate the labial cortex and extend in the soft tissue can mimic nasolabial cysts. The presence of characteristic radiographic features and their intraosseous location helps in differentiating with NC.3 Benign soft tissue neoplasms such as minor salivary gland tumours, neurofibromas, schwannomas or lipomas can be distinguished from a nasolabial cyst based on their solid consistency and lack of enhancement. Lesions usually diagnosed in childhood such as dermoid and epidermoid cysts arising in mid-nasal or laterally below nasal ala can be distinguished with NC which is almost invariably present in adults. A distinguishing feature of these cysts may be their yellow hue, as opposed to the normal pink or bluish colour of NC. Mucoceles can be differentiated with NC with a history of trauma in the nasolabial region and fluctuation in the size of the swelling.3,7-9

As NC is a cystic lesion arising from soft tissue, plain radiography does not depict any characteristic findings. Cystography plays an important role in defining the borders and extent of the cyst helping in diagnosis and treatment planning, where advanced radiographic techniques (CT, MRI etc) cannot be accessed, or patients cannot afford expensive investigations. Although complications such as secondary infection shouldbe kept in mind.10 CT and MRI (magnetic resonance imaging) help in providing soft-tissue images delineating the extensions of the lesion and studying the effectsof the cyst in surrounding structures.8,10 In the present case, a CT scan was done to identify the extent of this extraosseous cyst and its effect on the surrounding bone which revealed a depression / scalloping in theanterior maxillary bone, that could be attributed to the pressure effect from this long-standing lesion. Ultrasonography (USG) [specific sonographic and Doppler patterns] aids in establishing the anatomic origin, the local extension and the correct diagnosis in indeterminate cases, obviating other diagnostic imaging in soft tissue swellings of the anterior nasal fossa.11 A definitive diagnosis for this entity requires the correlation of the clinical, radiological and histological findings. The treatment options for NC include injection of sclerosing agents, marsupialization and surgical enucleation. Surgical enucleation through the sublabial approach is the most accepted mode of treatment.1,3,5 However, in the past 20 years, transnasal endoscopic marsupialization has emerged as an alternative approach. Very rare recurrence has been reported.6,9


A nasolabial cyst is an important lesion to be considered for the differential diagnosis of swellings in the nasal ala and sublabial region. Contrast radiography/cystography may be used in the diagnosis of the nasolabial cyst. Advanced imaging modalities like USG, CT and MRI can support the clinical diagnosis and facilitate treatment planning. Complete surgical enucleation of the cyst is the treatment of choice. Recurrence and malignant transformation are reported rarely.


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Financial or other competing interests: None.

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How to cite this article

Munde AD, Mishra SS, Patil S, et al. Nasoalveolar cyst - a case report. J Evolution Med Dent Sci 2021;10(45):4044-4046, DOI: 10.14260/jemds/2021/817

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