Clinical Characteristics of Odontogenic Cutaneous Fistulas

Abstract

BackgroundOdontogenic cutaneous fistula appears as dimpling or a nodule with purulent discharge, usually in the chin or jaw. Affected patients usually seek help from dermatologists or surgeons rather than from dentists. However, clinical symptoms of facial skin fistula without dental problems can lead to misdiagnosis.ObjectiveThe purpose of this study was to investigate the clinical characteristics of patients with odontogenic cutaneous fistulas.MethodsThis retrospective observational study was performed at Chungbuk National University Hospital by analyzing patients who visited from April 1994 to September 2014. Following clinical and radiographic examinations, the paths and origins of sinus fistulas were determined. Investigated factors were gender, age, morphology, location, originating tooth, time to evolution, recurrence, and treatment method.ResultsThirty-three patients (22 males, 11 females; average age 49.2 years) were examined during the investigation period. Thirty-four fistulas were diagnosed as odontogenic cutaneous fistulas. The most common morphology was dimpling (n=14, 41.2%). The various locations observed were related to the originating tooth. The most common site was the mandibular body related to mandibular molars. The referral clinical diagnosis was of odontogenic origin in 6 cases (18.2%). The majority of patients had experienced recurrence after treatment in previous clinics that had failed to diagnose odontogenic cutaneous fistula. Surgical fistulectomy and/or tooth treatment were performed in all cases. All patients were followed-up for 1 year. None showed signs of recurrence.ConclusionExtraoral and dental examinations are required to make a diagnosis of odontogenic cutaneous fistula. Thus, cooperation between dermatologists and dentists is essential.

Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge

“…The diagnosis was elusive in the absence of carious teeth and an unremarkable dental history, a clinical phenomenon reported in 50% of patients [ 4 , 8 – 10 ]. The diagnostic conundrum was compounded by the location of the dental infection to the fistulous aperture and its variability [ 1 , 3 , 9 ]. The nonspecific skin manifestation of an odontogenic cutaneous fistula may mimic a number of other disorders previously mentioned, justifying yet another reason why many patients seek care from a multitude of physicians before an accurate diagnosis is achieved [ 1 , 3 , 7 , 11 ].…”

“…The diagnostic conundrum was compounded by the location of the dental infection to the fistulous aperture and its variability [ 1 , 3 , 9 ]. The nonspecific skin manifestation of an odontogenic cutaneous fistula may mimic a number of other disorders previously mentioned, justifying yet another reason why many patients seek care from a multitude of physicians before an accurate diagnosis is achieved [ 1 , 3 , 7 , 11 ]. Our case demonstrates that failure of medical practitioners to effectively communicate and the lack of knowledge of odontogenic cutaneous fistulas lead to diagnostic and therapeutic misadventures as seen in this patient.…”

“…Typically, the absence of prompt diagnosis and treatment results in pulp necrosis and the spread of infection beyond the affected tooth into the periradicular tissues, which often lead to an apical periodontitis. The chronic process slowly evolves through the cancellous alveolar bone, following the path of least resistance until it perforates the cortical plate of the mandible, spreading to the surrounding soft tissues and erupting on the skin [ 2 , 3 ].…”

Esthetic improvement of a nasolabial cutaneous sinus tract

“…Significantly, previous misdiagnosis or inappropriate medical treatment and repeated recurrence have been shown in a retrospective study of Lee et al . [ 19 ] where 27 of 33 patients were transferred from general clinicians and had experience of one or more recurrence. All these authors have reported how important is the interaction between physicians and dentists to avoid submitting patients to multiple biopsies, antibiotic regimens, and unnecessary surgery, before correct diagnosis and endodontic therapy are in course.…”

“…The cutaneous sinus tracts are a sequel to pathosis, and the clinician should be able to recognize its primary cause. [ 9 18 19 ] They may appear months or even years after the dental pathology and are often not related to it. [ 1 ]…”