Common pitfall of plastic surgeon for diagnosing cutaneous odontogenic sinus

Abstract

Dental origins are a common cause of facial cutaneous sinus tracts. However, it can be easily overlooked or misdiagnosed if not suspected by a surgeon who is not familiar with dental origins. Cutaneous odontogenic sinuses are typically nodulocystic lesions with discharge and are most frequently located on the chin or jaw. This article presents two cases of unusual cutaneous odontogenic sinus presentations, as deep dimpling at the middle of the cheek. The patients were undergone surgical excision of sinus tract and dimpling immediate before and after treatment of causal teeth and the lesions resolved without recurrence. Surgeons should consider dental origins of facial dimpling lesions with discharge and provide appropriate treatment.

Cutaneous draining sinus tract of odontogenic origin

“…In addition, misdiagnosis can cause inappropriate and unnecessary treatment that might increase the chronicity of the lesion 2. Such treatment can affect facial aesthetics due to the appearance of skin scarring 8. Unnecessary excision of vital structures, as was suggested in this case (the parotid gland), may endanger facial nerves and arteries.…”

“…However, a dental infection should be suspected as the primary etiology in chronic draining cutaneous sinus tracts of the face and neck 5,7. This diagnosis might be easily overlooked by physicians, but not by dentists; however, many affected patients initially present to a physician for treatment 8. The osteoclastic process of the dental infection progresses gradually through the alveolar bone and may spread into the adjacent soft tissues, eventually breaking through the skin 7.…”

“…Cutaneous sinus tracts involving maxillary anterior teeth are likely to erupt on the upper lip region, the philtrum, nasolabial fold, nose or infraorbital region. Conversely, cutaneous sinus tracts involving maxillary teeth might erupt on the cheek 8. Misdiagnosis is common, as odontogenic cutaneous sinus tracts are uncommon 2.…”

Esthetic improvement of a cutaneous sinus tract of odontogenic origin

“…Cutaneous sinus tracts in the lower face is frequently described as an extraoral manifestation of pulpal-periradicular pathosis, might have other etiologies related to infectious disease such as mycobacterial infections, actinomycosis, deep fungal infections, osteomyelitis, or tumors such as pyogenic granulomas, epidermal cysts, squamous cell carcinomas, or congenital malformations such as thyroglossal duct cysts, brachial cleft cysts, and salivary gland fistulas [ 4 ]. Like our patient, affected patients usually search help from surgeons or dermatologists rather than dentists and often undergo multiple inappropriate treatments.…”

A Case of Odontogenic Fistula Misdiagnosed as Cutaneous Ulcer on the Alar-Facial Angle

“…Unnecessary biopsy should be avoided, as it can worsen inflammation and scarring. Delayed accurate diagnosis leads to unnecessary antibiotic treatment and improper surgical intervention, whereas clinical suspicion and timely radiographic examination can help prevent scars and unnecessary wasting of time and mon-ey due to biopsy or incisional drainage [11].…”