Large median palatine cyst

Median palatine cyst is a rare fissural cyst of nonodontogenic origin located in the midline of the hard palate, posterior to the palatine papilla. Only 21 cases have been reported in the literature, and documented here is a median palatine cyst of the largest dimension thus far.A 14-year-old male patient presented with a 5 × 5-cm² mass distal to the palatine papilla of 5 years' duration. Magnetic resonance imaging revealed a 5.3 × 4.6 × 4.2-cm³ cystic mass involving the midline of the hard palate. Complete enucleation of the cyst was performed with no recurrence, but an oronasal fistula developed 13 months postoperatively. A 1 × 4-cm ² posteriorly based oral mucoperiosteal rotational flap was designed, raised, and transposed to reconstruct the palate. The oral mucoperiosteal flap was viable, and no sign of fistula was found 3 years postoperatively.Treatment of medial palatine cysts through enucleation is known to be relatively simple and curative. However, large lesions may lead to large defects that require a method of reconstruction and may also elicit bony defects in the hard palate, leading to an increase in postoperative complications such as oronasal fistulas.We report our experience of a large median palatine cyst, the largest documented to date, with a brief review of the literature.