Median palatine cyst

The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine suture. There is controversy about its pathogenesis; however, its origin is generally attributed to the enclavement of epithelial remnants within the palatine suture between the 2 lateral maxillary processes during their fusion in the origin of the hard palate. The purpose of this report was to relate a case of a median palatine cyst, discussing the rarity of the lesion, its pathogenesis, and the different modalities that could be used for the correct treatment of this pathologic entity.     

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.     

Median palatine cyst

Median palatine cysts are rare, nonodontogenic lesion of the hard palate that do not involve the palatine papilla or incisive canal and that usually present as asymptomatic, fluctuant swellings. They may involve the floor the nasal cavity but are treated by simple enucleation, without recurrence. They are composed histologically of a fibrous collagenous tissue wall, with infiltration of chronic inflammatory cells, and lined by stratified squamous and/or respiratory epithelium. They are differentiated from the nasopalatine and other anterior maxillary cysts by the following diagnostic criteria: Appears grossly to be symmetrical along the midline of the hard palate. Located posterior to palatine papilla. Radiographically ovoid or circular in appearance. Not intimately associated with a nonvital tooth or found to have any communication with the incisive canal. Shows no histologic evidence of nerve trunks, large vascular spaces, hyaline cartilage, or accessory salivary gland tissue in the cyst wall.     

Le Fort I 型截骨术相关骨性解剖标志的多层CT测量研究

目的:应用多层CT影像测量上颌与LeFortI型截骨手术相关骨性解剖标志,为避免损伤腭降动脉提供指导.方法:选择60例正常成人上颌多层CT扫描图像,应用efilm1.94图像处理软件测量.结果:颧牙槽嵴至翼腭管的距离平均为26mm;翼突的宽度平均为13mm;犁状孔边缘至翼腭管的距离平均为37mm;前后鼻棘的距离为47mm;犁状孔边缘至翼腭管连线与矢状面的角度为7°8'.结论:参照测量获得的解剖数据在术中能降低腭降动脉损伤的发生率.     

CT analysis of a complicated nasopalatine duct cyst

A study was conducted to evaluate CT imaging in differentiating nonodontogenic nasopalatine duct cysts from odontogenic radicular cysts. The patient's palatine cystic lesion was analyzed by CT and excised with postoperative microscopic identification. CT findings of a nasopalatine cyst are midline location, smooth expansion with sclerotic margins and displacement of teeth apices. Radicular cysts differ in that the teeth apices are within the cyst rather than being displaced. We concluded that differentiation is clearly demonstrated by CT images.     

Mucus retention cyst of the maxillary sinus: the endoscopic approach

OBJECTIVE: To present our experience of endoscopic surgery for symptomatic mucus retention cyst of the maxillary sinus. DESIGN: Retrospective study. SETTING: Teaching hospital, Israel. PATIENTS: 60 patients with 65 symptomatic cysts of the maxillary sinus who were operated on endoscopically. Only patients with large cysts that filled at least 50% of the sinus space were included. INTERVENTION: A rigid nasal endoscope was used in all cases; most of the cysts were removed through the natural sinus ostium. RESULTS: Cysts recurred in only two patients during the first postoperative year. There were no complications from the procedure. CONCLUSION: The endoscopic approach to the treatment of maxillary sinus cyst is associated with a low rate of recurrence (3% in this study) and no complications, and we recommend it as the surgical procedure of choice.     

Epidermoid cyst of the external auditory canal in children: diagnosis and management

Epidermoid cyst of the external auditory canal (EAC) is rarely encountered in the clinical practice, but when it occurs, it may cause obstruction of the meatus that necessitates surgical excision. The aims of this study were to present 9 pediatric patients with epidermoid cysts of the EAC and to evaluate the outcome of the surgical technique that has been used in excision. Surgical removal of the cyst was carried out through a simple transmeatal approach, a medially based rectangular skin flap was elevated and the cyst was completely removed. No complications or recurrence have been reported. Epidermoid cyst should be listed in the differential diagnosis of EAC masses; it appears on computed tomography as a cystic mass in the outer cartilaginous part of EAC that is usually limited to the soft tissue with no bone erosion. It can be removed easily through simple transmeatal approach with high success rate and no morbidity.     

波及上颌窦的大型颌骨囊肿的治疗及临床效果

目的:探讨侵犯上颌窦的大型颌骨囊肿的治疗和临床效果。方法 :回顾2007-07—2015-03期间,在本院治疗的72例侵犯上颌窦的颌骨囊肿患者。A组(n=36)术中联合用超声骨刀和鼻内镜,彻底清除病变组织,保存正常窦内黏膜及骨骼外形;B组(n=36)术中用骨凿、咬骨钳去除骨壁,摘除囊壁组织后用刮匙搔刮囊腔及行上颌窦根治术。术后随访观察3~72个月,对术后并发症进行对比观察和统计学分析。采用SPSS13.0软件包对数据进行χ2检验。结果:A组患者在上颌窦瘘、面部畸形、鼻通气功能方面,术后并发症发生率显著低于B组(P<0.05);颌面部的美观和功能恢复良好。结论:术中用超声骨刀和鼻内镜治疗侵犯上颌窦的大型颌骨囊肿,保存正常窦内黏膜及骨骼外形,可明显降低上颌窦瘘和鼻通气下降的发生,颌面部的美观和功能恢复较满意。     

腭小神经对软腭功能影响的临床研究

目的：探讨腭裂整复术中保留腭小神经的临床意义。方法：选择先天性单侧完全性腭裂修复手术患者,腭小神经保留组和损伤组各15例,术前及术后1月检测软腭4种感觉功能,并用肌电图、鼻音计直接或间接检测软腭运动功能,最后用4个参数综合判断腭小神经损伤对软腭功能的影响。结果：保留腭小神经组软腭的感觉功能存在,而损伤腭小神经组软腭感觉功能消失;软腭的运动功能保留组明显优于损伤组。结论：腭裂整复术中保留腭小神经对恢复软腭感觉功能、腭咽闭合功能及早期的语音训练具有十分重要的临床意义。     

Nasal hair matrix cyst mimicking dermoid cyst

Dermoid cysts are primarily observed in the head and neck region. Nasal dermoids are uncommon. The terms nasal dermoid, nasal epidermoid, and nasal sebaceous cysts are used interchangeably by clinicians. Hair matrix cyst is a variant of epidermal cyst resembling the pattern of pilomatrixoma. Formerly, nasal hair matrix cyst has not been reported at all. Here, an additional pathologic proof is presented as well.     

Update of the classification of midpalatal suture behaviour after surgically assisted rapid maxillary expansion using computed tomography

The aim of this study was to update the midpalatal suture classification after surgically assisted rapid maxillary expansion (SARME) using computed tomography (CT). Thirty-five patients with a transverse maxillary deficiency and unilateral or bilateral posterior crossbite underwent SARME with osteotomy of the pterygoid apophysis of the sphenoid. CT was performed before installation of the Hyrax expander appliance and after the final activation. Opening of the midpalatal suture was classified into three types: type I, total midpalatal suture opening from anterior nasal spine (ANS) to posterior nasal spine (PNS); type II, partial midpalatal suture opening from ANS to the transverse palatine suture, with partial or non-existent opening of the midpalatal suture posterior to the transverse palatine suture; type III, complete maxillary opening from ANS, but not of PNS, because a paramedian fracture completed the opening of the hard palate. Type I was observed in 42.8% of the patients, type II in 40%, and type III in 17.2%. Opening of the transverse palatine suture was found in all midpalatal suture opening patterns and was more frequent in type III, followed by type II and type I. CT was used to update the classification of midpalatal suture patterns, with the inclusion of type III: total opening of the hard palate due partly to opening of the midpalatal suture and partly to a paramedian fracture.     

Detection and rapid increase of salivary antibodies to Staphylococcus lentus, an indigenous bacterium in rabbit saliva, through a single tonsillar application of bacterial cells

In rabbits, Staphylococcus lentus is one of the major bacteria in saliva and a minor bacteria in jejunum fluids and nasal wash. The presence and induction of naturally occurring antibodies reacting to rabbit indigenous bacteria were studied. In non-immune rabbits, the proportion of anti-S. lentus IgA antibodies to total IgA in the saliva was several times higher than that in the intestinal fluids and the nasal wash. The salivary antibodies were found to have increased 1 week after a single tonsillar application of isolated S. lentus cells but not after a single nasal application or a single intragastric instillation. In addition, the anti-S. lentus antibodies in the saliva highly increased with weekly tonsillar applications of isolated S. lentus but increased only one-fifth with weekly nasal applications of the same cells. These results strongly suggest that the palatine tonsils, which we believe had already been sensitized by S. lentus in the physiological condition, induced naturally occurring antibodies in rabbit saliva.     

Nasolabial Cyst: Review of Literature and a Case Report

The nasolabial cyst is a rare non-odontogenic cyst that develops within the skin adjacent to the ala of nose around the uppermost portion of the nasolabial crease; its pathogenesis is uncertain. This lesion grows slowly and measures between 1.5 to 3.0 cm; it is characterized clinically by a floating tumefaction in the nasolabial sulcus, which elevates the upper lip. The diagnosis is essentially based on the clinical findings. Bi—digital palpation revealed fluctulance between the floor of nasal vestibule and the gingivobuccal sulcus, which helps to confirm the diagnosis. This paper reports a case of a 35-year-old female patient that presented a soft swelling in the right ala of the nose; the clinical features suggested a nasolabial cyst. Complete surgical excision of the cyst was done under local anesthesia and the diagnosis was confirmed by histopathology. In spite of the low occurrence of nasolabial cysts, it is important to recognize the clinical characteristics of this lesion. The purpose of this paper is to review the literature and discuss the histopathology, etiology and different treatment options of this condition.     

Proteins in fluid from non-keratinizing jaw cysts

Abstract. Fluid from 41 non-keratinizing jaw cysts was examined by cellulose acetate membrane (CAM) electrophoresis. Improved separation with more regular protein profiles was obtained after digestion with bovine testicular hyaluronidase of two cyst contents exhibiting pronounced viscosity. CAM electrophoretograms of cyst fluid and serum contained the same protein fractions, with the exception of the β₂globulin band which was clearly demonstrated in only one cyst fluid, that from a median palatine cyst. Quantitation by scanning of the CAM eleclrophorelograms yielded contents of albumin, α₁-, and α₂-globulins which usually were proportionately lower in cyst fluid than in autologous serum while the β₁-globulin fraction was roughly similar. Relative concentrations of γ-globulins were significantly higher in cyst fluid than in autologous scrum, rising to as much as 56% of the total cyst fluid protein content. The γ-globulin band of cyst fluid generally was broad-based ("polyclonal" pattern). Within these broad γ-zones discrete, narrow, but well demarcated bands were occasionally seen ("oligoclonal" pattern). One cyst fluid exhibited a narrow-based γ-globulin band ("monoclonal" pattern). The electrophoretic patterns as well as other observations provide indirect evidence for the view that the bulk of the cyst fluid proteins are derived from the plasma and indicate that the γ-globulin fraction is a mixture of extravasated arid locally produced immunoglobulins.     

Endoscopic removal of a supernumerary tooth from the nasal cavity in an adult

Eruption of a tooth into the nasal cavity is a rare event. However it is important to identify such a condition as it has the potential to cause significant morbidity. We report a unique case of intranasal supernumerary tooth erupted into nasal causing significant nasal symptoms in an otherwise healthy patient which was removed endoscopically.     

3种径路鼻内镜下治疗上颌窦囊肿150例疗效分析

目的：探讨3种径路鼻内镜下治疗上颌窦囊肿的疗效差异。方法：分析近年来收治的150例上颌窦囊肿病例的临床资料,依据囊肿不同位置及是否伴有其他病变,对其采取3种不同手术径路切除,即经上颌窦自然口径路切除58例,经下鼻道开窗径路切除39例,经上颌窦前壁径路切除53例,评价3种径路的治疗效果。结果：150例患者,经过6～12个月的随访,术后鼻腔通气良好,面部胀痛、头痛、头昏等临床症状消失,经鼻内镜及鼻窦CT检查,无脓性分泌物,无囊肿复发。结论：根据上颌窦囊肿位置类型及伴有的疾病不同,鼻内镜下选择不同径路手术,上颌窦囊肿的术后康复效果更理想。     

A salvage procedure in cleft palate repair: suturing nasal mucosa directly to palatine process.

OBJECTIVE: Palatal fistulas are among the complications of cleft palate repair requiring additional surgery. Suturing the nasal mucosa and mucoperiosteal flaps together in a tension-free manner to create a double-layered closure in the hard palate is one of the most important points in prevention of dehiscence and fistula formation. In this report, we describe a salvage procedure to repair nasal mucosa that might be lacerated while being freed from the upper surface of the palatal process. METHOD: To restore the nasal lining, an ipsilateral vomer mucoperiosteal flap or the opposite nasal mucosa flap is advanced to the palatine bone and sutured directly to the palatal process in order to guarantee an intact cleft palate repair. RESULTS: This method is an easy, simple, and time-saving procedure. It should be a useful addition to the armamentarium of every plastic surgeon, especially those working as consultants in training units.     

A huge midline premaxillary cyst as a late complication of maxillary surgery

A median palatal cyst is an uncommon nonodontogenic cyst, and patients usually present with a painless swelling or the sensation of a mass. The mass is typically a well-defined fixed swelling along the midline. The mass can cause slight elevation of the nasal floor or swelling and drainage from the hard palate. Surgical resection is usually recommended as a definite treatment.We treated a 30-year-old man with a premaxillary mass with nasal obstruction. He had undergone surgery on both the maxilla and the mandible to correct malocclusion 10 years earlier. A physical examination revealed elevated mucosa of the nasal floor, resulting in near-total obstruction of the nasal cavity, and the gingival mucosa over the upper incisors was also swollen. Preoperative computed tomographic scan demonstrated a midline nonenhancing round cystic lesion in the premaxillary area. Surgical excision was performed via a sublabial approach under general anesthesia, and his recovery after surgery was uneventful.     

Nasal Mucosal Cyst a Clinical and Surgical Dilemma

A mucous cyst is a lesion which can show a wide range of symptoms but is benign and most of them can even appear several months or even years after nasal surgeries. Size of the displaced epithelial fragment is a crucial factor for the development of the mucous cyst. Complete resection of the mucous cyst is the ideal treatment. Surfing through the literature we came across 18 cases of mucous cyst formation following nasal surgery. Here we describe a mucous cyst which had resulted from a rhinoplasty procedure the patient had undergone earlier in her life.     

A rhinolith surrounded by a nasal polyp

Rhinoliths are uncommon mineralized nasal mass in children and adolescents. We reported a case of unilateral rhinolith that presented as a nasal polyp. A 29-year-old woman who had right-sided nasal purulent discharge, nasal obstruction, intermittent epistaxis, and posterior nasal drip for 6 months was admitted to our department. Nasal examination revealed a nasal mass between the inferior turbinate and the nasal septum, presenting as a nasal polyp or a nasal tumor. Paranasal sinus computed tomographic scan confirmed a calcified mass in soft tissue. We removed the rhinolith and the soft tissue that was around it with a transnasal endoscopic approach. Histologic analysis of the soft tissue identified inflammatory nasal polypoid tissue.