nasolabial cysts are also known as nasoalveolar cyst or klestadt cyst and were described in 1882 by zuckerkandl.1 
 2 they are rare,3 affecting 1.6 per 100,000 persons per year.2 they occur more frequently in females ( 4:1 ) , especially among african americans , in the fourth and fifth decades of life.2 
 4 
 5 in 90% of the cases , they are unilateral.5 their growth is slow and painless , so they are often underdiagnosed.1 
 2 
 3 
 6 
  patients typically complain of deformity and nasal obstruction .
signs and symptoms include nasal obstruction , local pain , swelling , and facial deformity.1 
 2 
 4 
 7 usually , there is a fullness of the canine fossa , the nasal ala , and nasal vestibule .
the bulging reaches the nasal cavity beneath the anterior third of the inferior turbinate , resulting in obliteration of the nasolabial fold and elevation of the alae of the nose.2 because of its close anatomical relation to the nasal cavity and teeth , it may become infected easily .
when it is infected , it grows quickly and may be painful.1 
  a nasolabial cyst is diagnosed by clinical examination and is confirmed by histopathologic study.1 
 2 usually , the nasolabial fold is obliterated .
the cysts must be palpated bimanually with one finger in the floor of the nasal vestibule and another in the labial sulcus .
imaging tests , like computed tomography ( ct ) of the paranasal sinuses and nuclear magnetic resonance ( nmr ) , may be useful.1 
 8 ct shows a cystic lesion located anterior to the piriform aperture ; its contents may be homogeneous .
cysts are hyperintense on t1 and isointense with cerebrospinal fluid on t2-weighted images at nmr , without changes after fat suppression.1 
 8 
  differential diagnosis includes cysts of the nasopalatine duct , periapical inflammatory lesions ( granuloma , cyst , or abscess ) , and epidermoid or epidermal inclusion cysts.1 
  complete surgical excision of the nasolabial cyst is the best treatment .
the most used incision is the sublabial.2 
 3 
 4 
 7 our aim is to describe the neumann incision to treat a giant nasolabial cyst .
a 37-year - old black man had bilateral nasal obstruction , which improved with saline nasal lavage and nasal corticosteroids .
two years later , he presented with bulging of the nasal vestibule , nasal deformity and asymmetry , and worsened nasal obstruction .
puncture of the right nasal vestibule was performed , removing 60 ml of serous liquid , relieving the symptoms . however , the lesion recurred with worsening of symptoms .
ct was performed and a cyst lesion anterior to the right pyriform aperture , 4    4.5    5.5 cm wide , was found , pushing the nasal septum to left and bulging the palate ( fig .
1 ) . 
 computed tomography ( 1 and 4 ) and surgical aspects ( 2 and 3 ) .
1 ) . histopathologic study revealed squamous and respiratory epithelium with chronic inflammatory process associated with histiocytic reaction .
the patient currently has no evidence of recurrent disease at 2 years postoperatively ( fig .
the first suggests that the cysts derive from inclusion cysts , secondary to mesenchymal cells after the fusion of medial and lateral nasal prominences to the maxillary prominence during facial skeleton formation .
the other theory suggests the cyst is an epithelial remnant of the nasolacrimal duct , running between lateral nasal and maxillary prominences.1 
 2 
  the most common histologic type is pseudostratified columnar epithelium , followed by squamous stratified epithelium and simple cuboidal epithelium.7 su et al assessed 10 cysts on electronic microscopy and noticed the cyst had a highly plicated mucosa and were made of nonciliated stratified columnar epithelium , including basal and goblet cells , structurally different from the ciliated columnar epithelium of the paranasal and nasal sinuses and airways.9 
  the treatment of nasolabial cysts consists of complete removal , aiming to prevent infections , define histologic type , and improve esthetics .
fine needle aspiration and cauterization are other treatment options available , but these techniques carry a high recurrence rate.1 as reported in the case , cyst puncture for pain relief should always be considered .
it became popular as an alternative to approaching the maxillary sinus in 1970 , replacing caldwell - luc technique.3 it consists of incision in the free edge of the gingiva in the region of the interdental papillae , from the medial portion of the lateral incisor to the lateral portion of the second premolar and first molar , with two vertical extensions , one medial and other lateral to the gingiva and labia , with subsequent elevation of the flap created , allowing full access to the pyriform aperture ( fig .
2 ) . after the intervention , the mucosal flap is put back into its original position , and the papillae are sutured with absorbable sutures and atraumatic needle , as well as the vertical extensions .
the incision considers the vessels and nerves in the region ; therefore , the local sensory disturbances such as bleeding are minimal .
the potential complications are facial swelling , insensitive gingiva , teeth numbness , and surgical site infection.3 
  the patient must be oriented to blow his or her nose and use a toothbrush on the surgical site .
dental prostheses can be used immediately after the surgery.3 
  choi et al described a series of cases in which the cysts varied in size from 1    1 cm to 3    5 cm.7 in the case reported , the cyst measured 4    4.5    5 cm , and during follow - up , no signs of recurrence or complications were noticed .
despite its rarity , nasolabial cysts should be considered in differential diagnosis when there is swelling of the floor of the nasal cavity or vestibule .
the neumann incision permits good access to the pyriform aperture and the complete cyst excision .
 
 introduction  a nasolabial cyst is an ectodermal development cyst . 
 it presents as a fullness of canine fossa , nasal ala , or vestibule of the nose . 
 it is rare and usually small . 
 treatment consists of complete surgical excision or transnasal endoscopic marsupialization . 
 objective  to describe a giant nasolabial cyst case treated using neumann incision . 
 case report  a 37-year - old man was referred to the otolaryngology department with nasal obstruction and nasal deformity . 
 computed tomography showed a nasal cystic lesion 4    4.5    5 cm wide . 
 surgical excision using neumann incision was performed . 
 
 discussion  neumann incision provides wide access to the nasal cavity and may be useful in nasolabial cyst treatment . 
Introduction
Case Report
Discussion
Conclusion