Aggressive Nasopalatine Cyst with Nasal Involvement in an Edentulous Patient

Round 1

Reviewer 1 Report

The authors provide an interesting case report of a rather uncommon clinical presentation of the nasopalatine duct cyst. There are several minor modifications that are warranted for manuscript acceptance.

1. Page 2, line 44. “The most frequent symptoms consist of….” Although most of the clinical findings represent symptoms, swelling and bluish appearance are considered clinical signs. Accordingly, suggest changing to: “The most frequent clinical signs and symptoms consist of….”

2.Page 4, line 112. “…cystic degeneration of epithelial remains….” Change to “epithelial rests.”

3. Page 4, line 123. “The lamina dura of the teeth remain intact.”  Change to “The lamina dura of the adjacent teeth remains intact.”

4. Should include a clinical differential diagnosis and include nasolabial cyst, salivary gland tumors (benign and possibly malignant), and schwannoma.

5. Need to include text regarding lesional recurrence rate. There are several published articles that provide this information, one of which has already been cited, notably #1.

6. References are not uniform in format with regard to page numbering and journal name (full name versus abbreviation).

7. Reference duplications: #1 and #4 AND #3 and #14. This will entail renumbering most of the entire manuscript (within text and in reference section). Be careful!!!

8. References #14 and #15 need page numbers.

Author Response

Dear Reviewer,

Thank you for your valuable suggestions.

We have modified the text taking into account all the points your raised.

Reviewer 2 Report

Dear Authors,

                       Scientifically, manuscript is sound but english needs to be slightly improved.

Author Response

Dear Referee,

We thank you for your suggestion. 

The text was revises by a medical english translater.

Reviewer 3 Report

I do not think that this case report add  unknown information  important data to the literature

Author Response

Dear Referee,

The purpose of this study was to report a unusual aggressive naso palatal duct cyst which to the best of our knowledge not frequently described. We feel that this case is of interest for the readers of the journal.

Reviewer 4 Report

Thank you for giving me

chance to do this review. Authors have 

been presented interesting case of NAsopalatine

cyst and its treatment. As reader I would like to

see dimensions (within CBCT, would you add

at your x ray sections) You have titled “aggressive “

however it has no clinical and radiological signs

of potentially malignant lesion. Have you performed

biopsy before surgery, and if you did not , why? Give

us your comments.

Have you got some postoperative photos ..? Healed? 

sincerely yours 
 

Author Response

Dear Reviewer,

Thank you for your comments.

As requested, we have now provided a new images with the dimension of the cystic lesion.

We consider this cyst aggressive because of the extension to the nasal cavity (rare in such type of cyst) and the destrcution of both vestibular and palatal cortex.

We didn't perform a biopsy because the patient was not willing to have two surgeries. We explained however that according to the histological result maybe an additional treatment will be necessary.

Clinically we obtained a good healing, but the patient was lost to follow up for radiological examination.

Reviewer 5 Report

The case report entitiled „Aggressive nasopalatine cyst with nasal involvement in an edentulous patient“ was written according to the authors' instructions. The introduction clearly describes the problem associated with nasopalatine cyst. The presentation of the case contains all the elements that relevantly describe the condition from the clinical examination, performed diagnostics and the histopathological examination. It is recommended to write the abstract as one paragraph.

 

Author Response

Dear Referee,

Thank you for your comments. In particular, as requested, we have presented the abstract in one paragraph. 

Round 2

Reviewer 4 Report

Dear authors thank you for your kind reply. It should be stressed in the text that the biopsy is always mandatory.  It would be good for the readers if you can import measurements within the images ( at the images regarding all three axes) You put 19X17X13. It seems as bigger. Please clarify that statement. The better option is to put in the text that the patient has been refused a biopsy (which must me signed by himself). 

 

sincerely yours, 

 

 

 

 

 

Author Response

Dear reviewer,

Thank you very much for your comments that have certainly improved the quality of our manuscript.

We have taken into account your remarks .

We have:

• stated the necessity of the biopsy prior the enucleation of the cyst in the Discussion section.
• the measurement of the lesion was verified and you were right the lesion is bigger than previously stated.
• In the Discussion section we have added that the patient refused the biopsy preferring the enucleation d'emblée. This was discussed with him during the consultation planning the surgical procedure. He signed therefore the consent for the enucleation (that we have provided at submission of the paper). Unfortunately he is since lost for follow-up, and we are unable  to ask him a new signed document. We hope you understand.

Thank you again.

Best regards.