Case Report/Clinical Techniques| Volume 47, ISSUE 7, P1177-1181, July 2021

Download started.


Use of Cone-beam Computed Tomography as a Critical Component in the Diagnosis of an Infected Nasopalatine Duct Cyst Mimicking Chronic Apical Abscess: A Case Report

Published:April 23, 2021DOI:


      Nasopalatine duct cysts (NPDCs) and other nonodontogenic lesions of the oral cavity may mimic odontogenic pathoses. We present a case of a 22-year-old man with a history of dental trauma and a lesion displaying the typical clinical and radiographic signs of a chronic apical abscess— a buccal sinus tract that was traced to a radiolucent area in the periapex of a maxillary central incisor. A comprehensive diagnostic process that included a cone-beam computed tomographic scan and a histopathologic examination of the lesion after complete enucleation led to the final diagnosis of an infected NPDC. The adjacent tooth was vital at the 1-year posttreatment follow-up, and a radiograph demonstrated complete healing of the periradicular structures. This case demonstrates the ability of NPDCs to present clinical and radiographic signs similar to apical inflammatory lesions and the need for a meticulous diagnostic process in order to avoid unnecessary endodontic intervention. The article also discusses the differential diagnoses of nonodontogenic lesions in the premaxillary area.

      Key Words:

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Faitaroni L.A.
        • Bueno M.R.
        • Carvalhosa A.A.
        • et al.
        Differential diagnosis of apical periodontitis and nasopalatine duct cyst.
        J Endod. 2011; 37: 403-410
        • Davido N.
        • Rigolet A.
        • Kerner S.
        • et al.
        Case of Ewing's sarcoma misdiagnosed as a periapical lesion of maxillary incisor.
        J Endod. 2011; 37: 259-264
        • Rodrigues C.D.
        • Villar-Neto M.J.
        • Sobral A.P.
        • et al.
        Lymphangioma mimicking apical periodontitis.
        J Endod. 2011; 37: 91-96
        • de Carvalhosa A.A.
        • Zandonade R.M.
        • de Souza C.
        • et al.
        8-year follow-up of central giant cell lesion mimicking apical periodontitis.
        J Endod. 2014; 40: 1708-1712
        • Hopp R.N.
        • Marchi M.T.
        • Kellermann M.G.
        • et al.
        Lymphoma mimicking a dental periapical lesion.
        Leuk Lymphoma. 2012; 53: 1008-1010
        • Suter V.G.
        • Büttner M.
        • Altermatt H.J.
        • et al.
        Expansive nasopalatine duct cysts with nasal involvement mimicking apical lesions of endodontic origin: a report of two cases.
        J Endod. 2011; 37: 1320-1326
        • Hilfer P.B.
        • Bergeron B.E.
        • Ozgul E.S.
        • Wong D.K.
        Misdiagnosis of a nasopalatine duct cyst: a case report.
        J Endod. 2013; 39: 1185-1188
        • Patel S.
        • Brown J.
        • Semper M.
        • et al.
        European Society of Endodontology position statement: use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by.
        Int Endod J. 2019; 52: 1675-1678
        • Special Committee to Revise the Joint AAE/AAOMR Position Statement on use of CBCT in Endodontics
        AAE and AAOMR joint position statement: use of cone beam computed tomography in endodontics 2015 update.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 120: 508-512
        • Swanson K.S.
        • Kaugars G.E.
        • Gunsolley J.C.
        Nasopalatine duct cyst: an analysis of 334 cases.
        J Oral Maxillofac Surg. 1991; 49: 268-271
        • Elliott K.A.
        • Franzese C.B.
        • Pitman K.T.
        Diagnosis and surgical management of nasopalatine duct cysts.
        Laryngoscope. 2004; 114: 1336-1340
        • Moss H.D.
        • Hellstein J.W.
        • Johnson J.D.
        Endodontic considerations of the nasopalatine duct region.
        J Endod. 2000; 26: 107-110
        • Shah P.N.
        • Arora A.V.
        • Kapoor S.V.
        Accessory branch of canalis sinuosus mimicking external root resorption: a diagnostic dilemma.
        J Conserv Dent. 2017; 20: 479-481
        • Suter V.G.
        • Sendi P.
        • Reichart P.A.
        • Bornstein M.M.
        The nasopalatine duct cyst: an analysis of the relation between clinical symptoms, cyst dimensions, and involvement of neighboring anatomical structures using cone beam computed tomography.
        J Oral Maxillofac Surg. 2011; 69: 2595-2603
        • Liang X.
        • Jacobs R.
        • Martens W.
        • et al.
        Macro- and micro-anatomical, histological and computed tomography scan characterization of the nasopalatine canal.
        J Clin Periodontol. 2009; 36: 598-603
        • Philbert R.F.
        • Sandhu N.S.
        Nonodontogenic cysts.
        Dent Clin North Am. 2020; 64: 63-85
        • Dedhia P.
        • Dedhia S.
        • Dhokar A.
        • Desai A.
        Nasopalatine duct cyst.
        Case Rep Dent. 2013; 2013: 869516
        • Aparna M.
        • Chakravarthy A.
        • Acharya S.R.
        • Radhakrishnan R.
        A clinical report demonstrating the significance of distinguishing a nasopalatine duct cyst from a radicular cyst.
        BMJ Case Rep. 2014; 2014 (bcr2013200329)
        • Borghesi A.
        • Nardi C.
        • Giannitto C.
        • et al.
        Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behaviour.
        Insights Imaging. 2018; 9: 883-897
        • Panneerselvam K.
        • Kavitha B.
        • Panneerselvam E.
        • Parameswaran A.
        Mural unicystic ameloblastoma mimicking odontogenic cyst.
        J Family Med Prim Care. 2020; 9: 2524-2527
        • Gondak R.O.
        • Rocha A.C.
        • Neves Campos J.G.
        • et al.
        Unicystic ameloblastoma mimicking apical periodontitis: a case series.
        J Endod. 2013; 39: 145-148
        • Derakhshan S.
        • Rahrotaban S.
        • Mahdavi N.
        • Mirjalili F.
        Metastatic renal cell carcinoma presenting as maxillary lesion: report of two rare cases.
        J Oral Maxillofac Pathol. 2018; 22: s39-s43
        • Umashankar D.
        • Srinath N.
        • Bavle R.M.
        • Bhandari A.
        Anterior maxillary metastasis of gastric adenocarcinoma: a rare case.
        J Oral Maxillofac Pathol. 2013; 17: 467-470
        • Selvi F.
        • Faquin W.C.
        • Michaelson M.D.
        • August M.
        Three synchronous atypical metastases of clear cell renal carcinoma to the maxillary gingiva, scalp and the distal phalanx of the fifth digit: a case report.
        J Oral Maxillofac Surg. 2016; 74: 1286.e1-1286.e9