A Case of Nasolabial Cyst in an Elderly Female

INTRODUCTION

Nasolabial cysts are rare soft tissue nonodontogenic cysts that develop between the nasal vestibule and upper lip.^[1] The incidence of nasolabial cysts is 0.7% of all maxillofacial cysts. The diameter ranges from 1-5 cm.^[2] Nasolabial cysts are often found in adult females in the 4^th-5^th decade of life. In 1953, Klestadt studied nasolabial cysts in-depth, after which the lesion was named Klestadt’s cyst.^[3] It is submucosal and extraosseous, spreads in the labial sulcus, and expands all the soft tissues outwards.^[4] Extraorally, it appears as a swelling between the upper lip and nasal aperture, causing elevation of the nasal ala.^[5] Clinically, the lesion presents as painless, asymptomatic swelling in the nasolabial region.^[6] When palpated, the lesion is soft and fluctuant in consistency. Common clinical features include a slowly growing painless mass, which results in obliteration of the nasolabial sulcus, nasal vestibule, and maxillary labial sulcus.^[6]

CASE REPORT

A 61-year-old female presented with a swelling on the left ala of the nose for 2 months, which was gradually increasing in size. On examination, there is a nontender cystic swelling of around 3×3 cm on the left side of the face, near the ala of the nose, pushing the ala [Figure 1]. An ill-defined bulge was noted in the gingivolabial sulcus on the left side. A computed tomography scan of the paranasal sinus showed a cystic mass in the subcutaneous plane adjacent to the ala [Figure 2]. She underwent surgical excision of the cyst via a sublabial approach [Figure 3]. The cyst was adherent to the mucosa of the floor of the nose. A small portion of the nasal mucosa was also excised with the cyst, and the defect was closed primarily. A nasal pack was kept, which was removed the next day.

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Figure 1: Clinical photograph of the patient showing a swelling near the left ala of the nose.

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Figure 2: Computed tomography scan coronal view showing soft tissue thickening in the subcutaneous plane on the left side of the cheek (arrow).

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Figure 3: Intraoperative image showing excision of cyst (arrow) by sublabial approach.

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The histopathological examination showed the cyst wall comprising fibrocollagenous tissue lined partly by cuboidal epithelium and partly by stratified squamous epithelium. In some areas, the lining is denuded and covered by granulation tissue. The stroma shows a dense mixed inflammatory infiltrate comprising lymphocytes, histiocytes, plasma cells, neutrophils, and eosinophils. Also seen is skeletal muscle. Histological features were suggestive of a nasolabial cyst [Figure 4]. The postoperative period was uneventful. The patient started oral feeds the following day. She is symptom-free in the 6-month follow-up period.

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Figure 4: Histopathology showing a cyst wall comprising fibro-collagenous tissue lined partly by cuboidal epithelium and stratified squamous epithelium (white arrow). In some areas, the lining is denuded (green arrow) and covered by granulation tissue (red arrow). The stroma (yellow arrow) shows a dense mixed inflammatory infiltrate comprising lymphocytes, histiocytes, plasma cells. neutrophils and eosinophils (H&E 10x). H&E: Hematoxylin and eosin.

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DISCUSSION

Nasolabial cysts are rare, nonodontogenic, soft tissue cysts occurring in the nasolabial region, also known as nasoalveolar cysts or Klestadt’s cysts. They account for <1% of maxillofacial cysts and typically present as asymptomatic swellings, though patients may seek medical attention when the cyst becomes infected or causes a cosmetic concern. While nasolabial cysts are developmental in origin, they usually manifest in adulthood, with the highest incidence reported in the 4^th-5^th decades of life. Bilateral involvement is uncommon, occurring in ∼10% of cases.^[6]

These cysts are submucosal, extraosseous lesions that expand via the gingivolabial sulcus, pushing adjacent soft tissues outward. Three main theories exist regarding their pathogenesis: (1) embryologic entrapment of epithelial remnants between the maxillary, medial, and lateral nasal processes, (2) retention of redundant epithelial cells from the inferior nasolacrimal duct, and (3) proliferation of misplaced endodermal cells from the nasolacrimal duct. Trauma and infection may contribute to accelerated cyst growth.^[7]

The differential diagnosis of nasolabial cysts includes midline cysts such as dermoid or thyroglossal duct cysts, odontogenic cysts, periapical abscesses, epidermoid cysts, furuncles at the nasal base, and neoplasms of the maxillofacial region. Unlike odontogenic cysts, nasolabial cysts do not involve the underlying bone or cause displacement of teeth. However, a case reported by Cohen and Hertzanu described an aggressive nasolabial cyst that eroded the maxillary alveolus, displaced adjacent teeth, and invaded supporting structures.^[8,9]

Imaging plays a critical role in diagnosis. Computed tomography (CT) typically reveals a well-defined, non-enhancing, hypodense lesion with no bony involvement, while magnetic resonance imaging (MRI) better delineates its soft tissue extent and relation to surrounding structures. Histopathologically, nasolabial cysts are lined by pseudostratified columnar epithelium with goblet cells, though stratified squamous epithelium may also be observed, as seen in the present case.^[10,11]

The gold standard treatment is surgical excision via an intraoral sublabial approach, which provides excellent cosmetic outcomes and a low recurrence rate. Alternative treatments include sclerotherapy with ethanol or OK-432, as well as endoscopic marsupialization, which is a minimally invasive option with reported recurrence rates ranging from 2.5-5%. A systematic review comparing treatment modalities showed that recurrence rates are lowest with complete surgical excision (1.6%), making it the preferred approach.^[8]

In our case, the intraoral sublabial approach was performed successfully, with complete removal of the cyst and an uneventful recovery. No recurrence or complications were observed in the 1-year follow-up, reinforcing the effectiveness of this method. Early diagnosis and definitive surgical management remain key to preventing complications and ensuring optimal functional and cosmetic outcomes.

CONCLUSION

Nasolabial cysts are rare, nonodontogenic lesions that can remain asymptomatic for years, often presenting in adulthood with swelling in the nasolabial fold. Although imaging aids in diagnosis, definitive confirmation is histopathological. Surgical excision via the intraoral sublabial approach remains the preferred treatment, offering excellent cosmetic outcomes and a low recurrence rate. Early recognition and management are essential to prevent complications and ensure optimal patient outcomes. It can also be noted that a nasolabial cyst can present in the elderly age group.