The effectiveness of decompression as initial treatment for jaw cysts: A 10-year retrospective study

Background: To assess the effectiveness of a psychoeducational intervention program designed to facilitate the performance of a series of steps of oral examination in children, adolescents and adults with autism spectrum disorder (ASD), in the Bio-Bio region, Chile. Material and Methods: A prospective, quasi-experimental study with pre-intervention, post-intervention and maintenance tests was carried out. Behavior was measured using Frankl’s scale and the number of steps of a dental examination completed (1-10 steps) was also recorded. Only 104 of the 188 subjects with ASD that agreed to participate in the study met all the inclusion criteria. Results: 82 people with ASD completed the psychoeducational intervention. The mean number of steps achieved pre- and post-intervention was 4.1 and 9.4, resulting in a clinically and statistically significant difference. Regarding behavior, the median in the pre-test was 2 (negative behavior) and in the post-test it increased to 3 (positive behavior), this difference being relevant and statistically significant. A maintenance test one month later on 63 people with ASD found no variations in behavior and in the number of examination steps completed. Conclusions: The proposed intervention was effective as an increase of more than 5 in the number of steps of examination completed was achieved. Frankl's behavior rating also increased, from negative to positive, in a group of children, adolescents and adults with ASD

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Clinical and histopathological features of nasopalatine duct cyst: A 47-year retrospective study and review of current concepts.

PURPOSE: To evaluate the clinical and histopathological features of nasopalatine duct cysts (NDCs) stored in the archives of a referred Oral Pathology Service over a 47-year-period, and to review current concepts about these cysts. MATERIAL AND METHODS: All NDCs were reviewed, and clinical data were obtained from the patient records. Thirty cases were re-evaluated microscopically by 2 oral pathologists. RESULTS: Among 14,564 cases, 30 (0.20%) were NDCs. Fifteen (50.0%) of the patients were female, and the mean age was 42.7 years. The lesions measured on average 2.37 ± 1.69 cm. Histologically, stratified squamous epithelium, alone or in combination with other epithelia, was present in 13 (46.6%) cases. Goblet cells and subepithelial hyalinization were common. Fourteen (46.6%) cases exhibited a slight degree of inflammation. Nerves were observed in 15 (50%) cases and mucous glands in 7 (23.3%). Hyaline ring granulomas (which is described here for the first time in NDC) and cholesterol crystals were not common. CONCLUSION: Knowledge of clinical-histopathological aspects of NDCs provides more accurate data about their nature and behavior. Our results suggest that the predominant epithelial lining of these cystic lesions is exclusively stratified squamous epithelium or combined with another type. Vessels, nerves, mucous glands and inflammatory infiltrate are frequently observed.

Odontogenic and nonodontogenic cysts: An analysis of 526 cases in Turkey.

PURPOSE: The aim of this study was to determine the age, gender, and sites of different types of odontogenic cysts (OCs) and non-OCs (nOCs) (seen in eastern Anatolian population in Turkey. MATERIALS AND METHODS: The following data were collected from the clinical records and histopathology reports of the Department of Oral and Maxillofacial Surgery and the Department of Oral Pathology, Ataturk University, Turkey, during a period of 10 years. They were analyzed descriptively in terms of incidence, age, sex, cyst type, and site. RESULTS: A total of 526 cysts were diagnosed during a 10-year period. Of these, 330 (62.7%) were in males, and 196 (37.3%) were in females, the male:female ratio was 1.7:1. There were 509 (96.8%) OCs and 17 (3.2%) nOCs. There were 406 (77.2%) inflammatory OCs and 103 (19.6%) developmental OCs. Radicular cysts were the most frequent (66.4%), followed by dentigerous (19.2%) and residual (10.8%) cysts. Only nasopalatine duct cyst was found as nOC in this study (3.2%). CONCLUSION: The distribution of jaw cysts in the Turkish Eastern Anatolian population is relatively similar to that of other populations reported in previous studies in the literature, in which most OCs were of inflammatory origin. However, the relative rates of cysts were higher than those reported in other studies.

Benign tumors and tumor-like lesions of the oral cavity and jaws: An analysis of 709 cases.

PURPOSE: The purpose was to examine the prevalence, gender, age and site(s) of odontogenic and nonodontogenic benign tumors, and tumor-like lesions occurring in the oral cavity and jaws in a Turkish population, particularly, in the Eastern Turkey, and to compare findings of this study with other reports. MATERIALS AND METHODS: The data were collected from the files of the Department of Oral and Maxillofacial Surgery and the Department of Oral Pathology, Ataturk University, Turkey, during a 10-year period from January 2005 to January 2015. They were analyzed descriptively regarding prevalence, age, sex, lesion type, and site. RESULTS: A total of 709 benign tumor and tumor-like lesions of the oral cavity, and jaws were selected during a period of 10 years. One hundred and twenty-one of these lesions (17%) were odontogenic benign tumors while 588 (83%) were nonodontogenic benign tumor and tumor-like lesions. CONCLUSIONS: This study revealed that the distribution and characteristics of benign tumors and tumor-like lesions of oral cavity and jaws in the Turkish population, particularly including the Eastern region of Turkey have some differences as well as similarities with the findings of studies in different populations.

Nonodontogenic Cysts of the Jaws and Treatment in the Pediatric Population.

Nonodontogenic cysts within the jaws are not a common presentation in the pediatric population. Cysts within the pediatric population tend to be developmental and odontogenic in nature. Although nonodontogenic cysts of the jaws are relatively uncommon, it is imperative the clinician understand their clinical behavior and management because failure to do so can result in increased patient morbidity. The nonodontogenic cysts of the jaws that are most often encountered are the central giant cell granuloma, traumatic bone cavity, aneurysmal bone cyst, nasopalatine duct cyst, and nasolabial cyst. This article reviews common clinical findings, radiographic features, histopathologic features, and current treatments of nonodontogenic cysts.

A case report on a nasolabial cyst presenting with a nasolacrimal sac cyst.

Nasolabial cysts are rare, nonodontogenic soft tissue developmental cysts that occur in the maxillary lip and nasal alar regions. Patients with this type of cyst generally presents with an asymptomatic soft swelling that may obliterate the nasolabial fold, elevate the nasal ala or the floor of the nose and fill the labial vestibule intraorally. The exact origin of nasolabial cysts is uncertain. The seed theory suggests that these cysts develop from a misplaced epithelium of the nasolacrimal duct because of their similar location and histologic appearance. This report aimed to present a case of nasolabial cyst presenting with a nasolacrimal sac cyst.

A rare case of bilateral nasolabial cysts.

Nasolabial cysts are rare non-odontogenic cystic lesions representing around 0.7% of all maxillofacial cysts. They usually present as unilateral painless swellings, sometimes with epiphora and dacryocystitis as well as pain in cases of rapid growth or infection. We have reviewed the literature and present an extremely rare case of bilateral nasolabial cysts in a young Afro-Caribbean man presenting with chronic nasal blockage, epiphora and rhinorrhoea. We describe our successful surgical management using a sublabial approach for complete excision, leading to a disease-free outcome at 6 months follow-up. Other modalities have been described, from endoscopic marsupialisation to simple aspiration. However, with the exception of complete surgical excision, all other surgical techniques are associated with a high recurrence rate. We therefore advocate complete surgical excision as described below for optimal results.

Nonodontogenic mandibular lesions: differentiation based on CT attenuation.

Mandibular lesions are classified as odontogenic and nonodontogenic based on the cell of origin. Odontogenic lesions are frequently encountered at head and neck imaging. However, several nonodontogenic pathologies may also involve mandible and present further diagnostic dilemma. Awareness of the imaging features of nonodontogenic lesions is crucial in order to guide clinicians in proper patient management. Computed tomography (CT) may provide key information to narrow diagnostic considerations. Nonodontogenic mandibular lesions may have lytic, sclerotic, ground-glass, or mixed lytic and sclerotic appearances on CT. In this article, our aim is to present various nonodontogenic lesions of the mandible by categorizing them according to their attenuations on CT.

A clinical report demonstrating the significance of distinguishing a nasopalatine duct cyst from a radicular cyst.

Endodontic diagnosis is challenging and depends on the organisation of information from the patient history, clinical examination and analysis of the pulp, radiographic and histopathological assessment. A 35-year-old man was endodontically treated for radiolucency in relation to the roots of maxillary central incisors as it was a provisionally diagnosed case of radicular cyst. Since the palatal swelling persisted, the lesion was re-evaluated using relevant diagnostic aids and a diagnosis of nasopalatine duct cyst (NPDC) was made, which was missed during the initial assessment. An erroneous interpretation of cystic radiolucency in relation to maxillary central incisors can often lead to inappropriate treatment planning. This case highlights the relevant aspects in the diagnosis of NPDC when it is mistaken for a radicular cyst and emphasises the need for thorough clinical examination and relevant investigations for periapical radiolucencies of questionable origin before initiating endodontic therapy.

Endoscopic endonasal marsupialization of nasopalatine duct cyst.

Nasopalatine duct cyst is one of the most common cysts among the nonodontogenic cysts in the maxillofacial area. This lesion usually does not show specific symptoms except for pressure from large cysts or infectious symptoms. Surgical removal including the epithelial lining is considered the treatment of choice. There are few reports of cases of endoscopic marsupialization treatment of large cysts, which have the risk of oronasal fistula. Here, we reviewed 3 cases of nasopalatine duct cyst treated with intranasal marsupialization and compared treatment results with those of conventional surgical enucleation. We suggest that endoscopic marsupialization could be used as an initial treatment option in selective cases.

Nasopalatine duct cyst as a complication of dental implant placement: a case report.

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies.

UNLABELLED: The nasopalatine region is composed of structures such as the vomeronasal organ and nasopalatine duct. The nasopalatine duct may provide the communication of the mouth to the nasal cavity in human fetuses and can be obliterated in an adult human. Knowledge on the development of the nasopalatine region and nasopalatine duct in humans is necessary for understanding the morphology and etiopathogenesis of lesions that occur in this region. OBJECTIVE: The aim of the present study was to describe the morphological aspects of the nasopalatine region in human fetuses and correlate these aspects with the development of pathologies in this region. MATERIAL AND METHODS: Five human fetuses with no facial or palatine abnormalities were used for the acquisition of specimens from the nasopalatine region. After demineralization, the specimens were histologically processed. Histological cuts were stained with methylene blue to orient the cutting plane and hematoxylin-eosin for the descriptive histological analysis. RESULTS: The age of the fetuses was 8.00, 8.25, 9.00 and 9.25 weeks, and it was not possible to determine the age in the last one. The incisive canal was observed in all specimens as an opening delimited laterally by the periosteum and connecting oral and nasal cavity. The nasopalatine duct is an epithelial structure with the greatest morphological variation, with either unilateral or bilateral occurrence and total patent, partial patent and islet forms. The vomeronasal organ is a bilateral epithelized structure located alongside the nasal septum above the incisive canal in all the fetuses. CONCLUSIONS: The incisive canal, nasopalatine duct and vomeronasal organ are distinct anatomic structures. The development of nasopalatine duct cysts may occur in all forms of the nasopalatine duct.

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies

The nasopalatine region is composed of structures such as the vomeronasal organ and nasopalatine duct. The nasopalatine duct may provide the communication of the mouth to the nasal cavity in human fetuses and can be obliterated in an adult human. Knowledge on the development of the nasopalatine region and nasopalatine duct in humans is necessary for understanding the morphology and etiopathogenesis of lesions that occur in this region. Objective The aim of the present study was to describe the morphological aspects of the nasopalatine region in human fetuses and correlate these aspects with the development of pathologies in this region. Material and Methods Five human fetuses with no facial or palatine abnormalities were used for the acquisition of specimens from the nasopalatine region. After demineralization, the specimens were histologically processed. Histological cuts were stained with methylene blue to orient the cutting plane and hematoxylin-eosin for the descriptive histological analysis. Results The age of the fetuses was 8.00, 8.25, 9.00 and 9.25 weeks, and it was not possible to determine the age in the last one. The incisive canal was observed in all specimens as an opening delimited laterally by the periosteum and connecting oral and nasal cavity. The nasopalatine duct is an epithelial structure with the greatest morphological variation, with either unilateral or bilateral occurrence and total patent, partial patent and islet forms. The vomeronasal organ is a bilateral epithelized structure located alongside the nasal septum above the incisive canal in all the fetuses. Conclusions The incisive canal, nasopalatine duct and vomeronasal organ are distinct anatomic structures. The development of nasopalatine duct cysts may occur in all forms of the nasopalatine duct. .

Inflammatory histopathogenesis of nasopalatine duct cyst: a clinicopathological study of 41 cases.

OBJECTIVE: The aim of this study is to characterize immunohistochemical profiles of lining epithelia of nasopalatine duct cyst (NPC) as well as to correlate those findings with their clinicopathological features to understand the histopathogenesis of NPC. MATERIALS AND METHODS: Forty-one surgical specimens from NPC were examined for clinical profiles and expression of keratin-7, 13, MUC-1, and P63 by immunohistochemistry, compared to radicular cyst (RC) and maxillary sinusitis. RESULTS: Nasopalatine duct cyst was clinically characterized by male predominant occurrence: 44% of the cases involved tooth roots, and 70% with inflammatory backgrounds. Lining epithelia of NPCs without daughter cysts were immunohistochemically distinguished into three layers: a keratin 7-positive (+) ciliated cell layer in the surface, a keratin-13+ middle layer, and a MUC-1+/P63+ lower half, indicating that they were not respiratory epithelia, and the same layering pattern was observed in RC. However, those immunolocalization patterns of the main cyst lining with daughter cyst were exactly the same as those of daughter cyst linings as well as duct epithelia of mucous glands. CONCLUSIONS: Two possible histopathogenesis of NPC were clarified: one was inflammatory cyst like RC and the other was salivary duct cyst-like mucocele.

Diagnosis and surgical management of nasopalatine duct cysts.

Nasopalatine duct cyst also known as nasopalatine cyst is a developmental, epithelial, non-neoplastic cyst that is considered to be the most common nonodontogenic cyst in the maxillofacial region. It is one of the many pathologic processes that may occur within the jaw bones, but it is unique in that it develops in only a single location--in the midline anterior maxilla. Nasopalatine cysts are usually asymptomatic and may be discovered during routine clinical and/or radiologic examination. The current study reports 18 cases of nasopalatine duct cyst that were diagnosed and treated at the Department of Oral and Maxillofacial Surgery at Ramadi Teaching Hospital, Anbar Province, Iraq. A correct diagnosis can only be made after proper clinical, radiographic, and histopathologic examination.

Large median palatine cyst.

Median palatine cyst is a rare fissural cyst of nonodontogenic origin located in the midline of the hard palate, posterior to the palatine papilla. Only 21 cases have been reported in the literature, and documented here is a median palatine cyst of the largest dimension thus far.A 14-year-old male patient presented with a 5 × 5-cm(3) mass distal to the palatine papilla of 5 years' duration. Magnetic resonance imaging revealed a 5.3 × 4.6 × 4.2-cm(3) cystic mass involving the midline of the hard palate. Complete enucleation of the cyst was performed with no recurrence, but an oronasal fistula developed 13 months postoperatively. A 1 × 4-cm(2) posteriorly based oral mucoperiosteal rotational flap was designed, raised, and transposed to reconstruct the palate. The oral mucoperiosteal flap was viable, and no sign of fistula was found 3 years postoperatively.Treatment of medial palatine cysts through enucleation is known to be relatively simple and curative. However, large lesions may lead to large defects that require a method of reconstruction and may also elicit bony defects in the hard palate, leading to an increase in postoperative complications such as oronasal fistulas.We report our experience of a large median palatine cyst, the largest documented to date, with a brief review of the literature.

The nasolabial cyst: a nonodontogenic oral cyst related to nasolacrimal duct epithelium.

Nasolabial cysts are interesting, relatively uncommon benign extraosseous maxillary lesions. We review current knowledge about epidemiology, symptoms, imaging modalities, pathogenesis, histopathologic and ultrastructural features, treatment options, and prognosis. Nasolabial cyst lining epithelium is characteristically composed of a basal layer of cuboidal cells and a luminal layer of columnar secretory cells with interspersed mucous goblet cells. In addition, areas of multilayered epithelium and squamous metaplasia may be seen. The cyst stroma is characterized by collagen-rich fibrovascular tissue with variably admixed chronic inflammatory cells. Furthermore, to our knowledge, we report the first example of immunohistochemical protein expression profiling of nasolabial cyst lining epithelium, discovering that basal layer cells express p63 and cytokeratin 5/6, while goblet cells express MUC-2 and MUC-5AC mucins, supporting the notion that nasolabial cysts can be understood as hamartomatous, locally expansile remnants of distal nasolacrimal duct development.