Nasopalatine Duct Cyst

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Nasopalatine duct cysts (NPDCs) are developmental, epithelial, nonneoplastic cysts that are considered to be the most common (32.8-73.2%) of the nonodontogenic cysts. ^{[1, 2]} Nasopalatine duct cyst is one of many pathologic processes that may occur within the jawbones, but it is unique in that it develops in only a single location, which is the midline anterior maxilla. Nasopalatine duct cysts usually present as unilateral pathology, but they may also occur bilaterally (approximately 0.25% of all cases). ^[3]

The development of the face and the oral cavity takes place between the fourth and eighth weeks of intrauterine life. The secondary palate is formed during the eighth and 12th weeks. In the midline between the primary and secondary palates, 2 channels (the incisive canals) persist. The palatine processes probably partly overgrow the primary palate on either side of the nasal septum. Thus, the incisive canals represent passageways in the hard palate, which extend downward and forward from the nasal cavity. Just before exiting the bony surface of the hard palate (incisive foramen or incisive fossa), the paired incisive canals usually fuse to form a common canal in a Y shape. ^[4] Nasopalatine canal evaluated by cone-beam CT scanning can be classified into 3 groups: type I (a single canal), type II (2 parallel canals), and type III (Y-type canal). ^[5]

The fusion of facial processes in the embryologic development of the maxilla results in the formation of a pair of epithelial strands (the nasopalatine ducts) that traverse the incisive canals downward and forward, connecting the nasal and oral cavities. The nasopalatine duct leads from the incisive fossa in the oral cavity to the nasal floor, in which it ends in the nasopalatine infundibulum. ^[6]

The types of epithelia that line the nasopalatine duct are highly variable, depending on the relative proximity of the nasal and oral cavities. The most superior part of the ducts is characterized by a respiratory-type epithelial lining. Moving downward, the lining changes to cuboidal epithelium. In the most inferior portion closest to the oral cavity, squamous epithelium is the usual type. In addition to the nasopalatine ducts, branches of the descending palatine and sphenopalatine arteries, the nasopalatine nerve, and mucus-secreting glands are present within the incisive canals. ^{[4, 7, 8]} In some vertebrates (eg, snakes), the nasopalatine duct plays a role in the reception of odorants. ^[9]

The nasopalatine ducts ordinarily undergo progressive degeneration; however, the persistence of epithelial remnants may later become the source of epithelia that gives rise to a nasopalatine duct cyst, from either spontaneous proliferation ^{[4, 10, 11, 12]} or proliferation following trauma (eg, removable dentures, dental implant treatment), ^[13] bacterial infection, or mucus retention. ^{[4, 11, 14, 15, 16]}

Genetic factors have also been suggested. ^{[11, 17]}

The mucous glands present among the proliferating epithelium can contribute to secondary cyst formation by secreting mucin within the enclosed structure. ^[18] Nasopalatine duct cysts can form within the incisive canal, which is located in the palatine bone and behind the alveolar process of the maxillary central incisors, or in the soft tissue of the palate that overlies the foramen, called the cyst of the incisive papilla. ^[19]

United States

Data concerning the prevalence of nasopalatine duct cysts differ considerably, with rates of 0.08%. ^[20] to 33%. ^[21] having been reported. Nasopalatine duct cysts account for approximately 12% of all jaw cyst tumors. ^[22] They occur in both black and white populations. ^[14] During last 50 years in the English-language literature, fewer than 500 cases have been published. ^[23]

International

In a Turkish study, of12,350 patients studied, 452 odontogenic cysts (98.5%) and seven nonodontogenic cysts (1.5%) were found; all the nonodontogenic cysts were nasopalatine duct cysts. ^[24] In a Brazilian autopsy study of 10,311 oral biopsy specimens, 58 met the criteria for nonodontogenic cysts, 19 of which were nasopalatine duct cysts. ^[2]

No racial predilection is known. Nasopalatine duct cysts that occur in young Afro-Caribbeans appears to be more clinically aggressive than those that occur in other ethnic groups. ^[11]

Males are affected 1.1-20 times more often than females, ^{[1, 18, 25, 26, 27]} although the predilection for males is not so obvious in all studies. ^{[2, 11, 28, 29, 30]}

Nasopalatine duct cysts occur over a wide age range (7-90 y), and they also occur in fetuses. ^{[2, 14, 31]} Most patients who are affected are aged 30-60 years, a with mean age of 46.2 years. ^{[1, 2, 10, 32, 33, 34]}

Complete postsurgical bony regeneration is expected in most patients. After surgical treatment, recurrence is uncommon, having been reported in 0-11% of patients. ^{[8, 19, 28, 30]} Only two cases of malignant change in the lining epithelium of a nasopalatine duct cyst have been published. ^{[35, 36]}

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Piotr Kurnatowski, MD Professor, Department of Otolaryngology, Medical University of Lodz, Poland

Disclosure: Nothing to disclose.

Deborah Cleveland, DDS Director of Oral Pathology, Associate Professor, Department of Oral Pathology, Biology and Diagnostic Sciences, Rutgers New Jersey Medical School

Deborah Cleveland, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, South Dakota State Medical Association, Teratology Society, Texas Orthopaedic Association, Wisconsin Medical Society, Southeastern Dermatological Association, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Southern Medical Association, Southern Orthopaedic Association, Southern Society for Pediatric Research, Southern Thoracic Surgical Association, Southwest Pediatric Nephrology Study Group, SWOG, Southwestern Surgical Congress, Special Operations Medical Association, Swedish Medical Association, Sydenham Society, Tennessee Medical Association, Tennessee Radiological Society, Texas Medical Association, Texas Pediatric Society, Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Jacek C Szepietowski, MD, PhD Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Nasopalatine Duct Cyst

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