Is the Median Palatine Cyst a Distinct Entity?

Report of a Case A 59-year-old man sought our attention for a dental abscess in the maxillary palatal site that was successfully treated with antibiotics. A panoramic radiograph was obtained, and a radiolucent area was evidenced in the maxillary median site (Fig 1). The patient had undergone surgery for a right maxillary inflammatory apical cyst about 5 years earlier. A computed tomography maxillary scan was performed that confirmed a wide radiolucent area, well separated from the teeth, on the median line of the palatal aspect (Figs 2, 3). The patient denied pain, purulent discharge, nasal congestion, or constitutional signs of fever, shakes, chills, night sweats, or weight loss. Teeth near the lesion presented after root canal therapy and a fixed bridge; no nasal floor elevation was noted during nasal cavity examination with a nasal speculum. After an explanation of risks and benefits, the patient provided informed consent. Under local anesthesia with 2% mepivacaine and conscious sedation with intravenous diazepam, the cyst was enucleated with preservation of the nasopalatine bundle, which was anterior to the cyst (Figs 2-4); the defect was then closed primarily with resorbable sutures. The patient was discharged on the same day, and the postoperative period was uneventful. On histopathologic examination, the surgical specimen fulfilled all 5 criteria required to define a median maxillary cyst, because no evidence of hyaline cartilage, large vascular spaces, nerve trunks, or accessory salivary gland tissue was found in the cyst’s wall (Figs 5, 6). Therefore the diagnosis of inflamed cyst of uncertain origin containing keratin was made.