Odontogenic Cutaneous Draining Sinus

Abstract

The aim of the present article was to discuss an unusual case report of the odontogenic cutaneous sinus with emphasis on diagnosis and treatment. The causative factor in this case was diagnosed intraoperatively due to infected follicular space in absence of any sign and symptoms. Timely diagnosis of the case could have prevented significant morbidity due to mistreatment medically and surgically with eventual recurrence.

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“…If the biopsy material was sent to the lab the findings would be granulomatous tissue, pseudoepitheliomatous hyperplasia and chronic inflammation [23][24][25][26]. Usually it can misguide the diagnostics, as there are other entities that can generate fistulas, pyogenic granuloma, salivary gland fistulas, congenital fistulas, infected cysts, deep mycosis infections, actinomycosis, thyroid cyst, pustules, furuncles, reactions to foreign bodies, skin carcinomas such as basal cell and squamous cancer, inverted follicular keratosis, dacryocystitis, suppurative lymphadenitis, tertiary syphilis and tuberculosis [27,28]. Rarely periapical abscess and fistulas generate complications, as mentioned before, osteomyelitis and sepsis [6].…”

“…If it cannot, it is best to remove it and complete resection of the fistula as well. There should be administration of systemic antibiotics if the patient is diabetic, immunosuppressed or has signs of systemic infection [26][27][28][29]. Once the infection is treated the sinus tract will heal in 5-14 days and closes by secondary intention, but the esthetic results are not so favorable; patients present scaring and depressions of the skin, which is why it is always recommended surgical removal of the fistula [9].…”

“…The maxillary incisors will most likely drain into the base of the nose and the canine into the internal part of the eye. There are less cases with drainage sites located distant to the affected area such as chest, muscles and sacral region [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The diagnosis of a fistula requires suspicion, a well done medical history and an adequate physical and oral examination and sensitivity test.…”

Dental Sinus Infections- why are we still missing the well documented diagnosis?

“…More often than not, the literature delivers the same message; that the lesions are diagnosed incorrectly and thus treated late and ineffectively. The cutaneous tracts tend to occur more frequently as a result of infected mandibular teeth (80%) more than infected maxillary teeth (20%) (1)(2)(3)(4)(5)(6)(7)(8).…”

“…They undergo multiple surgical excisions or biopsies which cause unnecessary scarring, further courses of antibiotic therapy, and even occasional radiotherapy with eventual recurrence of the cutaneous sinus tract and all because the primary dental cause is frequently misdiagnosed. However, if the correct diagnosis of the sinus tract is identified, the problem can be managed with a simple and effective treatment that comprises removal of the infected pulp canal tissue, which subsequently results in minimal cutaneous scarring (2,3,5,6,(8)(9)(10).…”