Endoscopic marsupialization of nasolabial cysts with added mucosal flap spacer prevents recurrence

Abstract

Management of a nasolabial cyst typically involves surgical excision via a sublabial approach but the thin plane of dissection may lead to a cyst rupture, or a breach of the nasal mucosa. Endoscopic endonasal marsupialization has been recently described, but there is a risk of fistula stenosis and cyst recurrence especially for small nasolabial cysts with small intranasal components. We describe a modification of the endoscopic endonasal marsupialization technique by incorporating an inferiorly based flap that acts as a spacer to prevent recurrence. The procedure is performed under general anesthesia. With endoscopic guidance, the intranasal cyst wall is incised from a posterior superior to anterior inferior direction. The medial cyst wall is left pedicled inferiorly, trimmed to size and is rolled into the cyst cavity to act as a spacer. This technique has been performed in 4 patients with cyst sizes ranging from 9 to 29 mm with no recurrences at least 6 months postoperatively. Previous reports have described recurrence at 6 months after endoscopic marsupialization, despite an intranasal cyst opening of 10 × 10 mm. This simple modification of the previously described endoscopic marsupialization technique has successfully prevented stenosis and recurrence even in patients with small nasolabial cysts.