Nasopalatine Duct Cyst with Impacted Inverted Mesiodens: A Rare Case Report and Literature Review

Abstract

Nasopalatine duct cyst (NPDC) is a non-odontogenic, developmental epithelial cyst that accounts for 1% of maxillary cysts. It often arises due to the spontaneous proliferation of the epithelial tissue remnants, although trauma, bacterial infection, and mucous retention may also trigger the proliferation. Owing to its slow-growing, asymptomatic nature, the cyst is often discovered as an accidental finding during routine clinical and radiographic examinations. However, the majority of cases present as a tiny, asymptomatic swelling just posterior to the palatine papillae. Radiographically, it appears as a well-defined oval or round radiolucency in the maxillary anterior teeth region and should be differentially diagnosed with inflammatory periapical lesions and a wide incisive foramen. A pulp vitality test is essential to rule out lesions of endodontic origin. Microscopically, NPDCs display a mixed pattern of the epithelial lining and exhibit neurovascular bundles (small to medium-sized nerves, arteries, and veins), and minor salivary glands in the cystic connective tissue, a distinctive feature facilitating a confirmatory diagnosis. Enucleation and marsupialization remain the treatment of choice. NPDC associated with impacted mesiodens is an extremely uncommon entity. A comprehensive literature search carried out on the PubMed and Google Scholar search engines revealed only three cases of NPDC with impacted mesiodens to date. The purpose of this study is to report an extremely rare case of NPDC associated with an impacted inverted mesiodens in a 19-year-old male patient who presented with an asymptomatic swelling in the maxillary anterior teeth region. To the best of our knowledge, this is only the fourth reported case of NPDC with impacted mesiodens.

Endodontic Treatment for a Mesiodens: A Case Report

“…Mesiodens can lead to severe complications, such as intraoral infections, cyst formation, delayed eruptions of permanent teeth causing significant discomfort, structural damage to the jaw, and prolonged treatment processes, which may involve surgical interventions and long-term management [1][2][3]. In rare instances, incisors may even erupt on the nasal floor, posing significant risks to oral health, such as severe infections, airway obstructions, and speech difficulties, necessitating immediate and specialized dental interventions, to prevent further complications and ensure proper oral function and aesthetics [11].…”

“…It does not harm adjacent teeth (radiographically and clinically) [1,2]. It causes periapical infections like cysts [11].…”

“…It is impacted or partially erupted [7,11]. Ethically, we cannot extract a tooth without the patient's consent; if he wants to save it, we should consider it while planning his pain relief.…”

Nasopalatine Duct Cyst Treated by Transnasal Endoscopic Marsupialization: A Case Report

“… 4 , 5 The exact pathophysiology of this lesion is still unknown, but it is believed that the remnants of the nasopalatine duct degenerate spontaneously into cysts. 6 While some researchers have proposed that NDCs originate from the spontaneous growth of epithelial tissue, the causes of these cysts are still unclear. 7 A central giant cell granuloma, a root cyst associated with the upper central incisors, a supernumerary tooth follicular cyst (usually mesiodens), a primordial cyst, a naso-alveolar cyst, osteitis with palatal fistulization, and bucco-nasal and/or bucco-sinusal communication are considered to be the differential diagnosis of NPCs.…”

A Custom-Made Surgical Guide for Accurate Enucleation of Nasopalatine Duct Cysts: A Technical Note and Case Report

“…These cysts originate from epithelial remnants in the nasopalatine duct [ 2 ]. The etiopathogenesis of nasopalatine duct cysts remains uncertain; however, some reports suggested that they arise due to the spontaneous proliferation of residual epithelial tissue due to several factors, such as mechanical trauma, bacterial infection, or mucous retention [ 3 , 4 ]. Cyst enucleation is a general treatment for nasopalatine cysts.…”