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CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 75-78

Median palatal cyst in a 7-year-old child: A case report


1 Department of Pedodontics and Preventive Dentistry, KLR Lenora Dental College, Rajahmundry, Andhra Pradesh, India
2 Department of Pedodontics and Preventive Dentistry, Al-Badar Rural Dental College and Hospital, Gulbarga, Karnataka, India
3 Department of Orthodontics and Dentofacial Orthopedics, HKE Society's S Nijalingappa Institute of Dental Sciences, Gulbarga, Karnataka, India
4 Department of Oral and Maxillofacial Surgery, KLR Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India

Date of Web Publication18-Mar-2016

Correspondence Address:
Balakrishna Kandarpa
Department of Pedodontics and Preventive Dentistry, KLR Lenora Dental College, Raja Nagaram, Rajahmundry, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.178986

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  Abstract 

The median palatal cyst is a developmental cyst at the midline of the palate, usually presenting as an asymptomatic swelling, located just behind the maxillary central incisors. It is the most common non-odontogenic cyst of the jaws, but is rarely seen in children. The median palatal cyst has recently been identified as a possible posterior version of the nasopalatine duct cyst. The purpose of this paper is to report an unusual case of a median palatal cyst in a 7-year-old boy who presented with a slow-growing swelling in the anterior palatal region and management of the cyst.

Keywords: Maxillary, median palatal duct cyst, non-odontogenic cyst, palate


How to cite this article:
Kandarpa B, Pushpalatha H M, Patil V, Nag A. Median palatal cyst in a 7-year-old child: A case report . J NTR Univ Health Sci 2016;5:75-8

How to cite this URL:
Kandarpa B, Pushpalatha H M, Patil V, Nag A. Median palatal cyst in a 7-year-old child: A case report . J NTR Univ Health Sci [serial online] 2016 [cited 2022 Jan 20];5:75-8. Available from: https://www.jdrntruhs.org/text.asp?2016/5/1/75/178986


  Introduction Top


A cyst is defined as a pathological cavity lined by a membrane and may contain liquid or semisolid material.

Cysts in maxillary, mandibular, and perioral regions vary greatly in histogenesis, incidence, behavior, and treatment. [1] Studies have reported that the median palatine duct cyst is an intraosseous developmental, epithelial, and non-odontogenic cysts of the oral cavity, representing up to 1% of all maxillary cysts. [2]

The median palatal duct cyst was first described in 1914 by Meyer as a paranasal sinus. [3] The maximum incidence is 40-60 years of age and these lesions are more frequent in males than in females, with a 3:1 ratio. [4] Due to a lack of representative studies, it is not fully clear whether redian palatine cysts are more common across different races and ethnicities. [5] These lesions are uncommon in children, especially in Caucasian children. The origin of median palatine duct cysts origin is uncertain; many authors now suggest that median palatine cysts develop from the epithelial remnants of the oronasal ducts within the incisive canals (proliferation theory).

Many etiological factors have been proposed: Local trauma, ill-fitting dentures, bacterial infection, mucous retention of adjacent salivary glands, and spontaneous proliferation. Racial or genetic factors are other possible causes mentioned in the literature, but the role of each has been questioned. [6]


  Case report Top


A 7-year-old boy reported to the Department of Pediatric Dentistry with the chief complaint of swelling in the anterior region of the palate for one month. History revealed that swelling began one month prior and gradually grew to it present size. There was no history of pain or bleeding from the site. Medical history was non-contributory and the child was not on any medication. Extraorally, there was no abnormality or associated lymphadenopathy. Intraoral examination revealed a bluish discoloration at the incisive papilla region. The swelling was sessile, non-tender, measuring approximately 1.5 × 1.5 cm in the midline of hard palate, and extended posteriorly up to the mesial aspect of first permanent molar [Figure 1]. Radiographic examination of the occlusal view showed a well-circumscribed oval-shaped radiolucency located in midline of the anterior maxilla between the roots of the central incisors [Figure 2]. The differential diagnosis included the conditions such as an enlarged nasopalatine duct, central giant cell granuloma, a root cyst associated with the upper central incisors, a supernumerary tooth follicular cyst (normally mesiodens), primordial cyst, nasoalveolar cyst, osteitis with palatal fistulization, and bucconasal and/or buccosinusal communication. [7] As the swelling was asymptomatic and was in the midline of the hard palate, ovoid in shape, not associated with a non-vital tooth, a provisional diagnosis of median palatine cyst was made. The treatment plan included surgical excision of the lesion under local anesthesia. Prior to surgery, all preliminary investigations were done and results were within normal range. Informed consent was obtained. Mucoperiosteal flap was raised to expose the cyst [Figure 3]. A friable, hemorrhagic cyst lining was curetted and sent for histopathological examination along with fine needle aspiration cytology (FNAC) [Figure 4]. The operative and histopathological findings confirmed the same. Patient was recalled, showed satisfactory healing after 3, 15, 30 and 40 days postoperatively [Figure 5]. Patient was followed up for a period of one year without any signs of recurrence.
Figure 1: Pre-operative clinical photograph

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Figure 2: Pre-operative occlusal view radiograph

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Figure 3: Intra-operative photograph

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Figure 4: Excised specimen

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Figure 5: Post operative healing photographs after 3, 15, 30, 40 days

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The other oral and radiographic findings included root stumps of 64, 74, and 84; proximal caries associated with root resorption of 65; and missing 54 [Figure 6]. Extraction of root stumps and carious teeth were done, followed by fixed space maintainers [Figure 7].
Figure 6: Other oral and radiographic findings

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Figure 7: Post-op photograph

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Histopathologic examination

Microscopic examination revealed fibrous wall lined by thin stratified squamous epithelium and partly by pseudo stratified columnar epithelium. A few nerve bundles and blood vessels were seen in the cyst wall. These histological features, in conjunction with the site of lesion, suggested a median palatine duct cyst, which is regarded as a rare entity at this age.


  Discussion Top


The median palatine duct cyst is a developmental cyst derived from proliferation of embryonic epithelial remnants of the nasopalatine duct. It may occur at any age, but is most commonly seen in the fourth to sixth decades of life. [6] In the largest study of 334 median palatine duct cysts, [8] the overall mean age was 42.5 years. In accord with the majority of studies so far reported in literature, these lesions mainly manifest between the fourth and sixth decades of life, with predilection to males. [6] The literature also reports, these lesions are uncommon in children though there have been few reports of median palatine duct cysts in pediatric patients up to 8 years of age. [9] In this case, the spontaneous cystic degeneration of residual ductal epithelium is the most likely etiology, which is enclosed within the incisive canal and not disappeared before birth, as normal. [10] On radiograph, the nasopalatine duct cyst is often misdiagnosed for a large incisive foramen. This case is of particular clinical interest as it is rare for a median palatine duct cyst to present in such a young patient and is therefore important that the clinician should be aware of the features of this cyst, as nearly 40% of the cases are totally asymptomatic and found only during routine clinical examination. [11] Due to extent of the lesion, surgical enucleation was the choice of treatment. Some authors propose marsupialization of large cysts, but the relapse rate is higher. [4] Our case demonstrated typical clinical, radiographical, and histopathological features of median palatine duct cyst, including its presence in the midline, ovoid shape, not in communication with the nasopalatine canal, lined by thin stratified squamous epithelium and partly by pseudo stratified columnar epithelium, and not keratinized.


  Conclusion Top


Median palatal duct cysts are of uncertain origin, and show a peak incidence between the fourth and sixth decades of life. In the absence of infection, median palatine duct cysts are asymptomatic. The tentative diagnosis was based upon clinical history and clinical exploration. Early surgical removal is advised in order to avoid possible malignant transformation. The definitive diagnosis was established by histo-pathological study of the lesion. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case. Following resection, relapse is unlikely, though a postoperative follow-up period of at least one year is recommended in all cases.

 
  References Top

1.
Omar RV, Palemón HS, Cruz Norberto J, Edmundo MC. Quiste del conducto nasopalatino: Reporte de un caso. Med Oral 2006;8:168-71.  Back to cited text no. 1
    
2.
Swanson KS, Kaugars GE, Gunsolley JC. Nasopalatine duct cyst: An analysis of 334 cases. J Oral Maxillofac Surg 1991;49:268-71.   Back to cited text no. 2
    
3.
Meyer A. A unique supernumerary paranasal sinus directly above the superior incisors. J Anat 1914;48:118-29.  Back to cited text no. 3
    
4.
Escoda Francolí J, Almendros Marqués N, Berini Aytés L, Gay Escoda C. Nasopalatine duct cyst: Report of 22 cases and review of the literature. Med Oral Patol Oral Cir Bucal 2008;13: E438-43.   Back to cited text no. 4
    
5.
Velesquez-Smith MT, Mason C, Coonar H, Bennett J. A nasopalatine cyst in an 8-year-old child. Int J Paediatr Dent 1999;9:123-7.   Back to cited text no. 5
    
6.
Gnanasekhar JD, Walvekar SV, al-Kandari AM, al-Duwairi Y. Misdiagnosis and mismanagement of a nasopalatine duct cyst and its corrective therapy. A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:465-70.  Back to cited text no. 6
    
7.
Moss HD, Hellstein JW, Johnson JD. Endodontic considerations ofthe nasopalatine duct region. J Endod 2000;26:107-10.   Back to cited text no. 7
    
8.
Staretz L, Brada BJ, Schott TR. Well-defined radiolucent lesion in the maxillary anterior region. J Am Dent Assoc 1990;120:335-6.   Back to cited text no. 8
    
9.
Ely N, Sheehy EC, McDonald F. Nasopalatine duct cyst: A case report. Int J Paediatr Dent 2001;11:135-7.  Back to cited text no. 9
    
10.
Agarwal S, Jagade M, Thorawade V, Mishra A, Joshi S, Ahire D. Palatal cyst: An unusual case report. Int Journal of Otolaryngology and Head and Neck Surgery 2013;2:39-41.  Back to cited text no. 10
    
11.
Swanson KS, Kaugars GE, Gunsolley JC. Nasopalatine duct cyst. An analysis of 334 cases. J Oral Maxiofac Surg 1991;49:268-71.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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