Diagnosis and management of bilateral nasolabial cysts
A 69-year-old female reported to the Dental college with a chief complaint of an extraoral swelling on the right side of her upper lip and elevation of the alar base [] since 7-8 months. History of present illness revealed that the swelling had increased in size since its initiation but was not associated with any pain, drainage through oral/nasal cavity or difficulty in breathing through nasal obstruction. Furthermore, there was no history of dacryocystitis/watery eyes but there was a swelling intraorally corresponding to this extraoral swelling which was obliterating the labial vestibule on that side.\nIntraoral examination revealed bilateral smooth, soft, fluctuant masses lateral to the central incisor teeth in the maxillary labial vestibule. The right-sided mass was well-defined [] and measured approximately 2 × 3 cm and left-sided mass measured 1.5 × 1.5 cm when palpated bimanually. Aspiration biopsy from right-sided mass revealed straw-colored fluid [].\nOcclusal radiograph [] showed a large scooped-out radiolucent area with ‘cupping’ surrounding upper left central incisor (UL1) in the middle and coronal thirds of its root, but not in the periapical area. Radiograph was noncontributory on right side. Provisional diagnosis of bilateral nasolabial cysts was made on the basis of above findings. Patient's informed consent was availed for the surgical removal of these cysts. Medical history did not present any contraindication for the surgical procedure.\nThe cysts were enucleated [ and ] using intraoral approach under local anesthesia and adrenaline (1:80,000). A full-thickness incision was reflected along the crest of maxillary alveolar ridge in the canine to canine region and blunt dissection by periosteal elevator exposed two smooth, well-circumscribed cystic swellings just below the nasal floor. There had been scooping of the anterior maxilla on the left side due to expansion of the cyst. In contrast, morphology of alveolar bone on right side was not affected. In the same appointment, extractions of hopeless teeth were also done and the wound was closed with loop sutures using 3-0 non-absorbable black mersilk after debridement and irrigation with normal saline. Postoperative instructions were delivered. Tissue was sent for histopathological confirmation.\nHistopathology of the right-sided cyst revealed a cystic cavity lined by variable thickness of epithelium predominantly made up of many layered stratified squamous cells along with a few mucosal cells []. At few places, stratified squamous and pseudostratified columnar epithelia with many cilia and goblet cells were also evident [Figure and ]. Capsule showed loosely arranged fibrous tissue infiltrated with dense diffuse chronic inflammatory infiltrate. Left-sided cyst specimen showed two or more layered stratified squamous lining epithelium with thin capsule []. Diagnosis confirmed the presence of bilateral nasolabial cysts.