What is Non-Odontogenic Cysts?

Non-odontogenic cysts, which are not related to tooth formation, are usually found during regular check-ups. These cysts come from tissues other than those involved in tooth development. They are defined by a lining of a thin layer of cells, known as the epithelium. Cysts in the mouth can differ in how they look, how frequently they occur, their cell structure, how they behave, and how they are managed.

We will discuss the symptoms, causes, and treatments of the following types of cysts: nasopalatine duct cyst (a cyst found in the roof of the mouth, where the nose and palate meet), nasolabial cyst (a cyst near the nostril and upper lip), palatal cyst of the neonate (a cyst in the mouth of a newborn baby), oral lymphoepithelial cyst (a cyst involving lymph tissue in the mouth), and the epidermoid cyst (a cyst that occurs in the outermost layer of the skin, which can also occur in the mouth).

What Causes Non-Odontogenic Cysts?

Nasopalatine duct cysts are cysts that develop from leftover tissue from a nasal canal called the nasopalatine duct. The root cause can be several factors such as infection, trauma, or retention of mucus (buildup of mucus).

Nasolabial cysts also develop from leftover tissue. So far, there are two hypotheses for how these cysts develop. One hypothesis is that the cyst forms from remaining skin cells (epithelial) left in the tissue (mesenchyme) after the nasal structures have merged. The other suggests that this kind of cyst stems from left-over skin cells from the nasolacrimal duct (a channel that allows tears to drain from the eye to the nose), found near the nasal structures and the maxillary prominence. However, it is not determined which of these theories is correct.

Palatal cysts of the neonate, also known as Epstein pearls or Bohn’s nodules, happen due to entrapment of keratin (a protein found in the skin) within the palate, leading to the formation of a cystic lesion (a small bump or blemish filled with fluid). Epstein pearls are usually located along the center of the palate, while Bohn nodules are found over the hard part of the palate, often where it meets the soft part of the palate.

There are several theories about how oral lymphoepithelial cysts start; however, the most accepted one is related to oral lymphoid tissues, a part of the immune system (Waldyer ring in particular), and the build-up of shed-off skin cells within a dilated crypt (a kind of pocket-like structure).

Lastly, Epidermoid cysts start as leftover cells and are known as inclusion cysts. They come from the outer layer tissues (ectoderm) of the embryo. These cysts can also occur because of injury which forces skin cells into deep tissue layers, causing a cyst to form.

Risk Factors and Frequency for Non-Odontogenic Cysts

Nasopalatine duct cysts are the most common type of cyst in the anterior maxilla (front upper jaw). They occur more frequently in males, about three times more often than in females. However, there’s no relationship between cyst size and gender. The average age of people with these cysts is 47.

Nasolabial cysts, on the other hand, are relatively rare and make up only 0.7% of all maxillofacial cysts. These cysts often occur in adult females between their 40s and 50s. The average age of people with nasolabial cysts is 51.

Palatal cysts are very common in newborns; they are found in 60% to 85% of newborn babies. There’s no difference in how often they occur in boys and girls. A study found that babies born at full term are more likely to have palatal cysts compared to babies born after the normal gestation period.

Oral lymphoepithelial cysts are also rare and affect both genders equally. These lesions are commonly linked with Waldyer’s ring, including the palatine and lingual tonsils and the pharyngeal adenoids. They occur in 1.2% to 7% of cases. The average age of people with these cysts is 44.

Epidermoid cysts are rare and occur more frequently in males. The average age of people with intraoral epidermoid cysts is 28.

Signs and Symptoms of Non-Odontogenic Cysts

Nasopalatine duct cysts are an anomaly you can find in the upper jaw bones. They often appear clear on X-Rays and have a ‘heart-shaped’ appearance due to the nasal spine overlapping in the image. People with these cysts can have a painless, hard swelling on the roof of their mouth that can cross the centerline, and sometimes it may even drain fluid.

Nasolabial cysts are noticeable as painless swellings in the middle part of the face, along the area of the ‘laugh lines’ on the cheek. Their size can vary between 1 to 5 centimeters. These cysts feel soft when touched, and people usually report blocked nose or worries about their appearance because of these cysts.

Nasal blockage
Esthetic concerns

Palatal cysts seen in newborn babies are small, white to yellow nodules close to the middle line of the roof of the mouth. These hard-to-touch nodules may be just one or quite a few and are millimeters in size.

Oral lymphoepithelial cysts appear as yellowish-white nodules with comparatively smooth surfaces. They’re most commonly found on the underside or the sides of the tongue or the floor of the mouth, but can be discovered on any lining surface inside the mouth.

Epidermoid cysts usually show up on the floor of the mouth as slow-growing lumps that don’t cause discomfort. They are typically not found until they become larger in size. These cysts feel firm and fluctuant (wave-like) upon touching.

Testing for Non-Odontogenic Cysts

Nasopalatine duct cysts are observed under the microscope to have a lining of epithelial cells (the body’s surface cells) surrounded by blood vessel-rich connective tissue. Frequently, minor salivary glands are also found in the surrounding area. Tests are done on the teeth related to the cyst to check their function, this is to rule out that the cyst came from a tooth. These tests are also helpful in making sure that the cyst isn’t a periapical cyst or granuloma, which are tooth related conditions. The teeth involved with a nasopalatine duct cyst, usually, perform normally when tested.

Nasolabial cysts, when observed under a microscope, show a lining made-up of cells stacked on top of one another with periodical patches of flat skin cells. Creating a diagnosis involves comparing microscope findings with the symptoms a patient has.

Palatal cysts in newborns are diagnosed simply by a doctor’s examination. These types of cysts don’t require further tests.

Then there’s oral lymphoepithelial cysts. These cysts, when scrutinized under a microscope, appear as a pouch lined by skin cells surrounded by immune system tissue. Cancerous growth or abnormal cells are typically not seen.

Lastly, epidermoid cysts are diagnosed by checking if they are lined by thick, skin-like cells without skin appendages such as sweat glands in the connective tissue underneath. More advanced imaging methods, such as a CT scan, might show these cysts as well-defined, single-chambered, low-density growths.

Treatment Options for Non-Odontogenic Cysts

Nasopalatine duct cysts are usually treated with surgery. After the operation, it’s crucial to keep a close eye on the patient to see if the cyst has fully healed. Occasionally, the cyst might come back, but this is uncommon.

Nasolabial cysts, which are located just above the upper lip, are commonly handled with a non-aggressive surgical procedure. Thankfully, it’s unusual for these cysts to reappear after they’ve been removed.

Parents of newborns with palatal cysts (found on the roof of the mouth) can relax knowing that these cysts tend to disappear on their own over time. Recurring palatal cysts are extremely rare.

Oral lymphoepithelial cysts, found inside the mouth, are also removed with a fairly straightforward surgical procedure. Unlike some other types of cysts, it’s unlikely for oral cysts to reappear once they’ve been removed.

Epidermoid cysts, which grow just under the skin, are usually removed using a procedure that scrapes out the cyst. It’s pretty rare for these to come back after they’ve been removed.

For certain oral conditions, different explanations can be considered before arriving at a final diagnosis. These potential reasons include the following:

For Nasopalatine Duct Cysts, doctors consider:

Any odontogenic cyst: this can be a lateral periodontal cyst or a periapical cyst/granuloma
Enlarged incisive fossa
Central giant cell granuloma

For Nasolabial Cysts, the possibilities include:

Radicular cyst
Periapical abscess
Nasopalatine duct cyst
Benign mesenchymal tumors
Minor salivary gland tumors

For Palatal Cysts of the Newborn, the common considerations are:

Congenital epulis
Dental lamina cysts
Natal tooth

When diagnosing Oral Lymphoepithelial Cyst, doctors look into:

Branchial cleft cyst
Lipoma
Mucocele
Sialolithiasis

Finally, for Epidermoid Cyst, these are the potential causes:

Lipoma
Dermoid cyst
Oral lymphoepithelial cyst
Benign mesenchymal tumors

Diagnosing the exact condition requires careful consideration of these possibilities and conducting the appropriate tests to come to a correct conclusion.

What to expect with Non-Odontogenic Cysts

Nasopalatine duct cysts usually have an excellent chance of recovery with rare occurrence. These are often effectively treated by completely removing the cysts during a biopsy.

Nasolabial cysts also have an excellent chance of recovery. The complete surgical removal of these cysts tends to be curative, meaning it effectively treats the condition.

Palatal cysts in newborns also have an excellent chance of recovery. These cysts generally resolve on their own within a few weeks to a few months.

Oral lymphoepithelial cysts, which are harmless, also have an excellent chance of recovery. So far, there are no reported cases of these cysts recurring after treatment.

Epidermoid cysts typically have a good chance of recovery, with low to rare chances of the cysts coming back after removal.

Possible Complications When Diagnosed with Non-Odontogenic Cysts

Nasopalatine duct cysts might grow and lead to drainage inside the mouth. Such cysts might develop due to trapped mucus and poor drainage, which could lead to pain or a feeling of pressure when they get larger. Most of these cysts don’t have specific symptoms and can easily go unnoticed during routine check-ups.

Nasolabial cysts might look like both non-tooth-related and tooth-related lesions, so a microscopic study of the tissue is needed for a correct diagnosis.

The cysts in the roof of the mouth in newborns usually rupture on their own and generally don’t lead to complications.

Oral lymphoepithelial cysts typically don’t cause problems after they’re removed, and they don’t usually come back after being removed.

Epidermoid cysts, if they get bigger, could potentially cause complications like trouble breathing or speaking. Often, patients don’t realize they have these cysts until they notice an increase in size or start showing symptoms.

Nasopalatine duct cysts: Can grow, causing drainage inside the mouth. Can be caused by trapped mucus and poor drainage, leading to pain or pressure. Often symptomless and can go unnoticed.
Nasolabial cysts: Can resemble both non-tooth-related and tooth-related lesions. Microscopic study of the tissue is essential for diagnosis.
Palatal cysts of the newborn: Typically rupture on their own and don’t cause complications.
Oral lymphoepithelial cysts: Don’t cause problems after removal. Don’t typically recur after removal.
Epidermoid cysts: Can cause issues like difficulty breathing or speaking if they get larger. People usually don’t notice them until they are large or symptomatic.

Preventing Non-Odontogenic Cysts

Nasopalatine duct cysts, which are a kind of growth that can appear in the mouth, come about because of how the body develops. There’s no way to prevent them from happening. It’s important for patients to know if there’s evidence of these cysts showing up in any x-rays or scans. Doctors might recommend getting a small sample – a biopsy – of the cyst to make sure it’s not something else.

Nasolabial cysts, another type of mouth growth, also develop due to how a person’s body is formed. If a person has had this kind of cyst, it’s good to know that having it come back again is not common.

Palatal cysts of the newborn, which occur in the mouth of a baby, are a type of growth due to how the baby develops. Parents of babies who have these cysts don’t need to worry because these cysts go away by themselves over time.

Oral lymphoepithelial cysts, which are growths in the mouth, are also due to development in the body. If a person has these cysts, doctors will inform them and plan to remove them.

Epidermoid cysts are another type of growth that mostly occurs due to body development. They are usually managed in a way that is not intrusive, and doctors typically remove these cysts, which in most cases leads to their disappearance.