The nasolabial cyst: a diagnostic pitfall in conventional dental imaging

Located in the soft tissues of the anterior nasal floor and the alar base, the nasolabial cyst (NLC) frequently escapes detection during routine dental radiographic examinations. This extra-osseous nature predisposes to a late diagnosis, as the practitioner may interpret clinical signs as odontogenic pathology or overlook subtle radiological signs on a simple panoramic view.

This case report documents the journey of a 46-year-old female patient presenting with a slowly progressing right nasolabial fullness. The study by Hakiki and Akyol (2026) aims to demonstrate how a multimodal imaging approach — including Cone-Beam (CBCT), Computed Tomography (CT), and MRI — allows for resolving uncertainty where the orthopantomogram fails. The objective is to illustrate the specific radiological semiology of this lesion, notably the pressure-induced cortical remodeling without intraosseous extension, in order to ensure rapid surgical management.

The central clinical hypothesis is based on the need to integrate extraosseous lesions into the differential diagnosis whenever standard dental imaging fails to explain a swelling or discomfort in the anterior maxillary region.

Methodology and diagnostic approach

This clinical case report documents the management of a 46-year-old female patient presenting with progressive swelling of the right nasogenian region. The methodology is based on a multimodal diagnostic approach aimed at identifying an extra-osseous lesion not visible through conventional means.

• Initial radiographic analysis: Standard panoramic radiography, supplemented by a retrospective review of previous panoramic images to identify any omitted early signs.
• Advanced multimodal imaging: Use of three complementary imaging modalities for precise characterization:
  • Cone Beam Computed Tomography (CBCT).
  • Computed Tomography (CT).
  • Magnetic resonance imaging (MRI) for the evaluation of soft tissues and lesion extension.
• Surgical protocol: Complete excision of the lesion via a sublabial incision.
• Validation and follow-up: Histopathological analysis of the resected specimen for diagnostic confirmation and post-operative clinical follow-up at 8 months to evaluate the absence of recurrence.

The study focuses on the differentiation between intraosseous odontogenic pathologies and this extraosseous lesion located anterior to the right piriform aperture.

Results of clinical and radiological evaluation

The analysis of this clinical case concerns a 46-year-old female patient presenting with progressive swelling of the right nasogenian region. Investigations revealed a series of precise clinical and iconographic data, highlighting the extra-osseous nature of the lesion.

Observations by multimodal imaging

The diagnosis was based on an approach combining several imaging modalities, allowing the lesion to be differentiated from classic odontogenic pathologies:

• Panoramic radiograph: Initial and retrospective images showed only subtle and non-specific signs, leading to a lack of diagnosis during previous dental examinations.
• CBCT, CT and MRI: These examinations revealed a well-circumscribed cystic lesion, located in an extra-osseous position, anterior to the right piriform aperture.
• Bone impact: Imaging revealed mild cortical remodeling related to the pressure exerted by the cyst, but without any intraosseous extension.
• Origin: No associated odontogenic pathology was detected, confirming the independence of the lesion from the dental system.

Surgical and histopathological outcome

The procedure consisted of a complete excision of the mass via a sublabial incision. The post-operative results are as follows:

• Histopathology: The anatomo-pathological examination confirmed the diagnosis of nasolabial cyst.
• Clinical follow-up: At 8 months of follow-up, the patient showed no clinical or radiological signs of recurrence.

The absence of statistical data (p-values) is explained by the nature of this publication (single case report), focused on diagnostic precision and the morphological description of the lesion.

Clinical analysis of the diagnostic trap

This case report perfectly illustrates why the nasolabial cyst is often described as a "trap" for the dental surgeon. In this 46-year-old patient, the lesion developed extra-osseously, which explains why the initial panoramic radiographs showed only subtle and non-specific signs, systematically overlooked during previous examinations. The slow clinical progression — a simple fullness of the right nasolabial region — reinforces this risk of diagnostic delay.

The main interest of this publication lies in demonstrating the effectiveness of multimodal imaging. While CBCT allowed for the identification of cortical remodeling by pressure at the level of the right piriform aperture, it was the association with CT and MRI that confirmed the well-circumscribed and strictly extra-osseous nature of the mass. This approach was decisive in ruling out a pathology of odontogenic origin and planning the excision via a sublabial incision.

Although the results are limited to a single case, the 8-month follow-up without recurrence validates the adopted therapeutic strategy. The study reminds that in the presence of asymmetry of the alar base or the nasolabial region, the absence of obvious intraosseous radiographic signs should not lead to a wait-and-see approach, but on the contrary, should guide towards examinations targeting soft tissues.

Summary of results

This case report documents the diagnosis of a nasolabial cyst in a 46-year-old female patient, a benign extraosseous lesion that went unnoticed during several conventional dental panoramic examinations. The use of multimodal imaging (CBCT, CT, MRI) allowed for the identification of a circumscribed mass at the base of the piriform aperture, treated by sublabial surgical excision with no recurrence after 8 months of follow-up.

In concrete terms, for the practitioner:

• Distrust of 2D: Do not rely solely on dental panoramic radiographs to exclude pathology when faced with nasolabial swelling; the extra-osseous nature of these cysts often makes them invisible or non-specific on standard radiographic images.
• CBCT/MRI reflex: In the absence of obvious odontogenic pathology (positive vitality tests, absence of periapical lesion), prescribe a CBCT to evaluate cortical remodeling or an MRI to precisely characterize the soft tissue lesion.
• Surgical protocol: Sublabial excision is the gold standard approach, providing direct access to the anterior nasal cavity while avoiding cutaneous scarring.

Technical lexicon of the study

Nasolabial cyst: Rare extraosseous benign lesion developing within the soft tissues of the anterior nasal floor and the base of the ala of the nose.

Cortical remodeling: Morphological alteration of the bone surface caused by mechanical pressure from an adjacent lesion, observed here at the level of the piriform aperture without intraosseous invasion.

Piriform aperture: Anterior bony limit of the nasal cavity serving as a critical anatomical landmark for the localization of masses in the nasolabial region.

Multimodality imaging: Diagnostic approach integrating several techniques (CBCT, CT scan and MRI) to precisely characterize the relationships between soft tissues and bone structures.

Sublabial incision: Surgical approach performed in the upper buccal vestibule, allowing access and enucleation of cysts in the nasal region without skin scarring.

Extra-osseous lesion: Pathology whose origin is located exclusively in the peripheral soft tissues, which can make it undetectable during conventional dental radiographic examinations (panoramic type).

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