Cutaneous draining sinus tract: An odontogenic etiology

doi:10.1016/S0190-9622(86)70012-1

Journal of the American Academy of Dermatology

Volume 14, Issue 1, January 1986, Pages 94-100

https://doi.org/10.1016/S0190-9622(86)70012-1 Get rights and content

Although the most common cause of the intermittently suppurating cutaneous sinus tract in the face and neck area is chronic dental infection, chronic draining sinus tracts of the face and neck continue to be a diagnostic challenge. The attending clinician must look carefully for a potential odontogenic infection; chronicity, lasting for weeks, months, and even years and the recognition of the lesion as a sinus tract are keys to making the correct diagnosis. Diagnostic errors can result in multiple surgical excisions and biopsies, long-term antibiotic therapy, and even radiation therapy or electrodesiccation. A review of 137 cases of cutaneous draining sinus tracts from the literature is presented, and four cases are reported. Conservative, nonsurgical root canal therapy is recommended as the first choice of treatment.

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Odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw with facial subcutaneous abscess formation: A retrospective clinical study of difficult-to-diagnose cases
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Citation Excerpt :
Treatments of odontogenic infection and ARONJ with facial subcutaneous abscess formation commonly consist of dental treatment and infection control, and removal of the fistula is usually not required. Dental treatment in the form of tooth extraction and/or endodontic treatment should be performed [13]. Since insufficient endodontic treatment can cause recurrence of external fistulas [2], careful follow-up after treatment is necessary.
The objective of this study was to analyze difficult-to-diagnose cases of odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw (ARONJ) with facial subcutaneous abscesses by otolaryngologists.
The study was conducted in the department of otolaryngology of a university hospital. Seven patients exhibiting odontogenic infection and ARONJ with facial subcutaneous abscesses diagnosed at the department of otolaryngology in our hospital from January 2008 to December 2018 were included in the study. We investigated the following information obtained from the patients: clinical department for initial treatment, sex, age, offending tooth, causative disease, site of the fistula, symptoms, methods of diagnoses, and therapy.
Odontogenic infection with facial subcutaneous abscess formation can occur in individuals in a wide range of age groups; however, the pathological manifestations of ARONJ are often observed in older women, frequently at the chin and accompanied by nodules and pain in the adjacent teeth. Computed tomography and orthopantomography are useful for diagnosis and are especially indicated for patients under long-term follow-up or with frequent recurrences. Magnetic resonance imaging, cytodiagnosis, and histological analysis might be necessary to exclude the possibility of tumors. Management of such facial subcutaneous abscesses comprises dental treatment and infection control, and f surgical removal of the abscess is usually not required. Treatments such as sequestrectomy and sitafloxacin administration are useful for patients with ARONJ.
Our results demonstrated that for patients with facial subcutaneous abscesses, involvement of odontogenic infection and ARONJ should be considered.
Cone-beam Computed Tomography as a Noninvasive Assistance Tool for Oral Cutaneous Sinus Tract Diagnosis: A Case Series
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An oral cutaneous sinus tract is a relatively uncommon condition that is generally associated with long-standing periapical inflammation. The traditional process of oral cutaneous sinus tract diagnosis is an invasive method based on the insertion of a lacrimal probe or wire. The present article describes the use of cone-beam computed tomographic imaging as a noninvasive assistant tool for the verification of the odontogenic origin.
An uncommon cause for a non-healing cutaneous fistula in the parotid gland area - A case report
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Citation Excerpt :
The goal of the treatment is to eliminate the source of infection. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were solved by surgical or conservative nonsurgical endodontic therapy [14]. Some earlier studies suggested that the sinus tract is lined with epithelium and propose surgical extraction of the tooth to achieve healing [15].
Orocutaneous fistulae of dental origin are uncommon but well documented in the literature. This condition is often misdiagnosed because of the multiplicity of manifestations and the atypically presentation of the condition. Dental symptoms are rare. This makes diagnosis and treatment a challenging process.
A 67-year-old patient presented in the emergency room with an abscess in the parotid area. After incision and drainage the patient developed a non-healing fistula in the region of the parotid. Multiple treatment attempts and several investigations did not solve the problem. Finally, a panoramic x-ray showed a hidden, infected and displaced tooth in the right mandibular angle. After surgical extraction of the tooth and fistula excision, healing was uneventful and there was no recurrence.
Given the diagnostic challenge, the real origin of the condition is frequently only discovered after several unnecessary interventions that may have harmed the patient. The key to early diagnosis is dental examination and dental radiographs. The goal of treatment is the elimination of the infection by surgical extraction of the tooth or non-surgical endodontic therapy.
Early diagnosis and rapid treatment minimize patient discomfort and reduce the probability of further complications. The differential diagnosis of sinus tract of dental origin should be considered in any case of unclarified non-healing skin lesion in the head and neck area, especially if initial treatments have failed. An early interdisciplinary approach is essential.
Odontogenic cutaneous sinus tract presenting as a growing cheek mass in the emergency department
2017, American Journal of Emergency Medicine
An odontogenic cutaneous sinus tract (OCST) is a rare extraoral sinus tract related to a chronic draining dental infection, typically apical periodontitis. OCST usually presents as an erythematous and non-tender nodule and often requires endodontic treatment for resolution of the sinus tract. If there is disruption of the mandibular cortex, it may be difficult to differentiate an OCST from a non-odontogenic malignant mass in patients without dental symptoms. This report describes a rare case of OCST presenting as a left cheek mass in a 21-year-old man which was initially diagnosed in the emergency department.
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2015, International Journal of Surgery Case Reports
Odontogenic cutaneous sinus tract is a relatively rare occurrence that can be complicated to diagnose. The presence of a cutaneous lesion is often not even partly associated with a dental etiology because of the less frequency of occurrence in the case of dental symptoms. Consequently, the underlying dental cause is often missed leading to inappropriate diagnosis and treatment.
Here, we report the case of a 45-year-old man who presented with a persistent lesion of the cervical region. At the time of presentation, the lesion had been present for approximately one year with a gradual increase in size but no specific symptoms. The patient had previously undergone punch resection under local anesthesia, which resulted in a histopathological diagnosis of inverted follicular keratosis. A diagnosis was made of an odontogenic cutaneous sinus tract secondary to chronic apical periodontitis of the left mandibular second molar.
Cutaneous sinus tract in the face and neck is most likely to develop intraorally. Root canal treatment or surgical extractions are the common treatment choices. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were treated by surgical or conservative nonsurgical endodontic therapy.
Early diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment.

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^*: The opinions or assertions contained in this article are those of the writers and are not to be construed as official or as reflecting the views of the Department of the Navy.

^**: Staff, Oral Diagnosis Department, Naval Dental School, Bethesda.

^***: Associate Professor, Department of Dental Diagnostic Science, Dental School, and Associate Professor, Department of Pharmacology, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at San Antonio.

^****: Chief of Dermatology, Naval Hospital, Naval Medical Command National Capitol Region.

View full text

Cutaneous draining sinus tract: An odontogenic etiology*

Oral Surg

J Am Acad Dermatol

J Pediatr Surg

J Am Acad Dermatol

Oral Surg

Oral Surg

Oral Surg

Oral Surg

Oral Surg

Am J Orthod

J Pediatr

Am J Surg

J Am Dent Assoc

Draining skin lesions of dental origin: The path of spread of chronic odontogenic infection

Plast Reconstr Surg

Chronic periapical infections

Cutaneous sinus tracts of dental origin

Arch Dermatol

Mandibular sinuses of dental origin

Practitioner

Facial sinuses of dental origin

Br J Surg

Tumor Conference No. 34: A dental sinus appearing as atypical epithelial hyperplasia that suggested a squamous-cell carcinoma

J Dermatol Surg Oncol

Dermal sinus of dental origin

Arch Dermatol

Cutaneous fistula of dental origin

J Oral Surg

Persistent sinus tracts of dental origin

Arch Dermatol Syph