Case Report

Globulomaxillary Cyst in a 16 year old male patient- A case report with review
Gargi Saran1,*, Deepak Umapathy2, Neeta Mishra3, Shiva Kumar Ganiga Channaiah 4, Sumalatha5, Puja Rai6
1,6Senior Lecturer, 2,4Professor, 3Professor & HOD, 5Reader, Dept. of Oral Medicine & Radiology, Babu Banarasi Das College of
Dental Sciences, Lucknow

*Corresponding Author:
Email: gogzy007@gmail.com

Abstract
Globulomaxillary cyst is an uncommon, specious cyst. It was traditionally described as a fissural cyst between the maxillary
lateral incisor and canine teeth, secondary to proliferation of entrapped epithelium between the globular portion of the medial
nasal and maxillary processes. They are painless, submucosal, non-odontogenic jaw cysts presenting as soft tissue swellings in
the maxillary anterior mucolabial fold lateral to midline. Present case documents 16 year old male patient with diffuse extra-oral
swelling present involving the philtrum and extending upto the nasolabial fold was observed on the left side of the face. Intra-
orally well-defined soft and fluctuant swelling was present with pus discharge. Radiographically, well defined heart shaped
radiolucency was observed in the left maxillary periapical region. The cyst was enucleated using intra-oral approach.
Histopathological findings revealed pseudostratified ciliated epithelium with overlying inflammatory cells and goblet cells.
Diagnosis of globulomaxillary cyst was confirmed.

Keywords: Non-odontogenic, Globulomaxillary cyst, Peri-apical radiograph, Radiolucency, Pseudostratified ciliated epithelium.

Access this article online seven days. History of present illness revealed that the
swelling had increased in size since its initiation but
Website: was not associated with any pain, although was
www.innovativepublication.com associated with pus discharge since last three days.
Extraoral examination revealed a localized diffuse
DOI: swelling, involving the philtrum and extending
10.5958/2395-6194.2016.00038.2 anteroposteriorly from ala of nose to 2 cm below cheek
prominence and superoinferiorly from 3 cm below
Introduction inner canthus of the eye to the corner of mouth.
Globulomaxillary cyst is a rare fissural cyst found Intraoral examination revealed smooth, soft,
within the bone between the maxillary lateral incisor fluctuant mass lateral to the cuspid teeth in the
and canine. The globulomaxillary cyst is found within maxillary labial vestibule. The mass was well-defined
the bone at the junction of globular portion of the red in colour [Fig. 1] and measured approximately 3× 2
medial nasal process and the maxillary process, the cm when palpated bimanually. On palpation the
globulomaxillary fissure, usually between maxillary swelling was soft in consistency and non-tender on
lateral incisor and cuspid teeth.1 palpation. A clinical provisional diagnosis of
Clinically the cyst develops between the maxillary periodontal abscess w.r.t 22 was given.
lateral incisor and cuspid teeth. Intraorally, it presents Radiological examination was performed in which
as a soft-tissue swelling of the maxillary anterior intra-oral periapical radiograph revealed well defined
mucolabial fold, lateral to midline leading to heart-shape radiolucency extending upto the periapical
obliteration of the nasolabial fold. Radiographically. It region with displacement of roots associated with left
exhibits as an "inverted pear-shaped radiolucency" in maxillary lateral incisor and canine. Maxillary occlusal
maxillary anterior radiographs. The globulomaxillary radiograph revealed well defined scooped out
cyst often causes the roots of adjacent teeth to diverge.1 radiolucency extending from maxillary left lateral
Embedded in the literature since years, this cyst incisor upto second premolar. Panoramic Radiograph
was included in the 1971 WHO classification of (OPG) with respect to left side revealed well defined
histologic typing of odontogenic tumors but removed in heart shaped radiolucency with loss of lamina dura
the second edition in 1992. Recently, it has been along with displacement of apical third portion of the
included as a fissural cyst secondary to proliferation of roots. [Fig. 2]
entrapped epithelium between the globular portion of Provisional diagnosis of globulomaxillary cyst was
the medial nasal and maxillary processes.2,3 made on the basis of above findings. Patient’s informed
consent was availed for the surgical removal of these
Case Report cysts. Medical history did not present any
A 16-year-old male reported to the Dental College contraindication for the surgical procedure.
with a chief complaint of an extraoral swelling since The cyst was enucleated [Fig. 3] using intraoral
approach under local anesthesia and adrenaline
Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, 2016; 2(3):164-166 164
Gargi Saran et al. Globulomaxillary Cyst in a 16 year old male patient- A case report with review

(1:80,000). Postoperative instructions were given. mixed inflammatory cells and endothelial lined blood
Tissue was sent for histopathological confirmation. vessels. [Fig. 4]. Diagnosis confirmed the presence of
Histopathological report revealed the H&E stained globulomaxillary cyst. The patient was kept at follow
section showed pseudostratified ciliated epithelium up for three months. Idoform dressing was changed at
overlying inflammatory cells. Epithelial lining also an interval of every fifteen days and the progress of the
showed goblet cells. Stroma showed pre-dominated cystic lesion was recorded.

Fig. 1

Fig. 2

Fig. 3

Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, 2016; 2(3):164-166 165
Gargi Saran et al. Globulomaxillary Cyst in a 16 year old male patient- A case report with review

Fig. 4

Discussion 4. Christ TF. The globulomaxillary cyst: an embryologic

Classically, the globulomaxillary cyst was misconception. Oral Surg Oral Med Oral Pathol.
1970;30:515–526.
considered to be an inclusion or developmental cyst that 5. NJ D'Silva, L Anderson - Oral surgery, oral medicine,
arises from entrapped non odontogenic epithelium in oral pathology, 1993.
the globulomaxillary suture.4 6. Zegarelli DJ, Zegarelli EV: Radiolucent lesions in
Fusion of facial processes does occur, and globulomaxillary region, J Oral Surg 1973; 31:767-771.
epithelium is entrapped in areas that later will lie 7. Neville BW, Damm DD, White DK. Color atlas of
between the maxillary lateral incisors and canines. The clinical oral pathology, 2nd ed. Hamilton: BC Decker
Inc.; 2003.
review argues that embryologically and 8. Norman K. Wood, Paul W. Goaz. Textbook of
histopathologically, globulomaxillary cyst should again differential diagnosis of oral and maxillofacial lesions.
be considered as an identifiable clinicopathological 5th Edition.;2007.
entity.5
The classic radiographic picture is of
globulomaxillary cyst is inverted pear-shaped or tear-
shaped, with well defined radiolucency between the
separated roots of lateral incisor and canine. This
should be differentiated from the anatomic depression
in the labial plate between the maxillary canine and
lateral incisor.6
The globulomaxillary area may be lined by
pseudostratified, ciliated coloumnar epithelium. In our
present case report the cyst pseudostratified ciliated
epithelium with goblet cells which confirmed the
provisional diagnosis of globulomaxillary cyst.7
Clinical differential diagnosis of globulomaxillary
cyst included odontogenic keratocyst (OKC) and
adenomatoid odontogenic tumor (AOT).8

Conclusion
In the presented case; clinical, radiographic and
histological features of the lesions were suggestive of
Globulomaxillary cyst residing on the alveolar surface)
on the left side, which were successfully enucleated by
a modification of intraoral sublingual surgical
approach. In three follow-up, no evidence of
complications or recurrence was observed.

References
1. Shafer's textbook of oral pathology. 5th edition;2004.
2. Mervyn Shear- Cyst of Oral and Maxillofacial Regions.
3rd edition;1992.
3. Sahin Caner. Nasolabial cyst. Case Report Med.
2009;586201.

Journal of Oral Medicine, Oral Surgery, Oral Pathology and Oral Radiology, 2016; 2(3):164-166 166