Dental infection simulating skin lesion

Abstract

Abstract:Orocutaneous fistulas or cutaneous sinus, a tract of dental origin, is an uncommon but welldocumented condition that usually requires emergency treatment. Such condition may be misdiagnosed by physicians and dentists and may sometimes be confused with bone and skin tumor, osteomyelitis, congenital fistula, salivary gland fistula, pyogenic granuloma, infected cyst, deep mycotic infection, and other pathologies. A case of facial sinus tract that was initially misdiagnosed by a physician as a nonodontogenic lesion is presented. Nonsurgical endodontic therapy was the treatment of choice for this case. Facial cutaneous sinus tracts must be considered of dental origin. Early diagnosis and prompt treatment minimize patient discomfort and esthetic problems, reducing the possibility of further complications such as sepsis and osteomyelitis. Keywords: Cutaneous fistula; Endodontics; Fistula; Focal infection, dental; Skin diseases Resumo: A fístula orocutânea de origem dentária é uma condição incomum, bem documentada e geralmente requer tratamento de urgência. Esta condição pode ser confundida por médicos e dentistas com lesões ósseas, de pele, nas glândulas salivares, osteomielite, granuloma piogênico, cisto infectado, infecção fúngica, entre outras. Um caso de fístula facial que foi inicialmente diagnosticado por um médico como uma lesão não-odontogênica é apresentado e discutido. O tratamento de escolha foi a endodontia do dente envolvido, sem necessidade de cirurgia. A possibilidade de infecção dentária deve ser considerada em casos de fístula cutânea na região orofacial. O diagnóstico precoce e tratamento imediato podem minimizar o desconforto do paciente e problemas estéticos, além de reduzir a possibilidade de outras complicações, como osteomielite e sepse.

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“…Vicentii, orphyromonas gingivalis Veillonella parvula, Enterococcus faecalis, Campylobacter gracellis and Neisseria mucosa invade the tooth through the enamel and dentin, infecting the pulp causing necrosis, periodontitis and formation of the periapical abscess, rich in anaerobic bacteria. Usually this process is acute and renders the patient to seek medical attention [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. With the passing of time between six months and 30 years, added to the partial and temporal recovery, symptoms may be masked meanwhile the infectious process continues and intensifies, becoming chronic.…”

“…With the passing of time between six months and 30 years, added to the partial and temporal recovery, symptoms may be masked meanwhile the infectious process continues and intensifies, becoming chronic. At this point, the purulent material finds a way out through an abnormal canal that connects the alveolar abscess with an orifice in the interior of the mouth (intraoral sinus tract), or into the skin (extraoral sinus tract) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Based on a recent report, extraoral fistulas are more common in women and adults and intraoral fistulas are usually found in children [16].…”

“…Only 50% of the patients feel pain or dental sensitivity, but there may be evident drainage which can produce esthetic problems [19]. The most common fistulas are associated with mandibular teeth in 80 to 87% of the cases, in a proportion of 4:1 between mandibular and maxillary unions and more common in anterior dental pieces like canine or incisor than posterior teeth [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. In other rare occasions it has been documented otherwise [13][14][15].…”

“…Topically, they are localized in the angles of the mandible, chin and cheeks, and most of the times it can be predicted where the fistula will drain, depending on what tooth is affected: the mandibular premolars and molars will drain into the submandibular regions by some into the cheek of the affected side as well. Meanwhile the same pieces, but on the maxillary region will drain directly into the cheek [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The maxillary incisors will most likely drain into the base of the nose and the canine into the internal part of the eye.…”

“…Fortunately, life threatening complications such as osteomyelitis and sepsis are not very common [5,6]. Whenever a patient has a facial o cervical fistula, it is mandatory a complete oral exploration looking for an odontogenic abscess besides a fibrous tissue (fistula) on the mandibular angles, cheeks or chin that connects jugal with gingival mucosa, causing the skin retraction [7][8][9]. It is necessary to be corroborated the periapical infection with a panoramic x ray, or it may be done by drawing the sinuous tract con radiopaque material such as gutta percha, and then takes the x-ray [10][11][12].…”