Nasopalatine Cyst (Roof of the Mouth Cysts)

Definition

A nasopalatine cyst is defined as a developmental cyst that occurs in nose and palate region. It originates in the midline of the palate, the front part of the roof of the mouth. The cyst is located very near to the teeth but its origin is not related to the tooth. A nasopalatine is the most commonly occurring non dental cyst. The cyst is believed to be formed from epithelial cell remnants present at the nasopalatine region. These cells undergo excessive replication and form a cystic lesion.

Symptoms

A well defined swelling at the front part of the palate is the first symptom. The swelling tends to be minor in the initial stages, located just behind the upper incisor teeth. The swelling has a bluish color and is mobile in nature. It may be hard or soft in consistency depending on the content of the fluid present inside the cyst. At this point it may be painless.

If the cyst gets infected, then the patient experiences pain .The swelling shows a tiny opening over the palatine papilla, which is associated with pus discharge. The pus discharge causes a salty taste in mouth. The cyst is located very close to the nerve supplying the teeth and palate. Therefore numbness or pain may be felt in upper teeth and roof of the mouth. A large cyst may cause the teeth to spread apart – migration of the teeth. If the cyst is too large, it can cause difficulty in biting and speaking. Larger cysts may also pose aesthetic problems.

Causes

A nasopalatine cyst is believed to be caused by proliferation of epithelial cells of embryonic origin. The factors inducing the cell proliferation are of various types.

  • Chronic trauma or repeated irritation to the front of the palate can cause proliferation of the embryonic cells. Trauma could be caused due to irregularly shaped teeth or habits such as grinding of the teeth.
  • Ill fitting dentures and direct blow to anterior palate region may also play a role.
  • Bacterial infections of the mouth or nose are also linked to development of the nasopalatine cyst.
  • Repeated mucous retention cysts are formed by minor salivary gland injuries. These mucoceles lead to accumulation of mucous and saliva. The pressure from these cysts may then trigger the development of a nasopalatine cyst.

Treatment

Differentiating nasopalatine cyst from other cysts and tumors can be achieved by dental x-rays and other diagnostic tests. After a definite diagnosis is established, treatment is carried out in two stages.

The small lesions need not be excised immediately. These cysts are followed-up with regular dental cheek ups. Dental x-rays are taken every 6 months. The patient is advised to maintain good oral hygiene practices to avoid secondary infections. In case secondary infections develop, the appropriate medication is then administered.

If the cyst becomes large and causes speech or aesthetic problems, surgical removal of the cyst is the treatment of choice. The cyst is excised surgically under local anesthesia. After removal of the cyst the site is thoroughly irrigated and all epithelial linings are removed to avoid recurrence. Even the smaller nasopalatine cysts are excised in case the patient is undergoing complete denture prosthesis.

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