Sinus tracts to the chin and jaw of dental origin

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This is a report of seven patients with cutaneous sinus tracts of dental origin who were seen in the past 10 years at the Mayo Clinic. Cutaneous sinus tracts of dental origin most commonly present on the chin or the mandibular region as nodulocystic lesions with suppuration. The lesion may be confused with pyogenic granuloma, foreign body reaction, deep fungal infection, squamous cell carcinoma, or osteomyelitis. However, if the lesion is suspected of being of dental origin, the diagnosis is easily confirmed by dental examination and dental roentgenograms of the involved area. Once the correct diagnosis has been made, treatment by appropriate endodontic therapy leads to prompt resolution of the sinus tract. This is an uncommon disease but one for which a high degree of alertness must be maintained when one sees a nodulocystic or ulcerative lesion of the face.

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    The difficulty in the healing of STs has been explained in the past with the presence of an epithelial lining throughout the tract8,30, which would hamper the closure of the pathologic pathway despite the adequate treatment of the root canal infection. Epithelialization as the cause of failure has been dispelled by the evidence that the persistence of infection was a more important reason for the lack of resolution of the ST11,31. Concentrations above the average of specific pathogens in intraradicular infection have been considered responsible for the poorer prognosis of teeth with chronic apical abscesses; yet, no significant differences were found between cases with and without STs in terms of total bacterial counts32.

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    In general, a periapical infection with an associated OCST is not painful although there is often a history of varying magnitudes of discomfort before ST development16. Only 50% of these patients experience dental pain, and the involved teeth are in most cases not tender to percussion5,16,17. The lack of specific intraoral symptoms and an unpleasant esthetic appearance might be the reason that patients usually do not relate the skin lesion to a dental origin.

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From the Departments of Dermatology and Dentistry, Mayo Clinic and Mayo Foundation.

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