Cutaneous draining sinus tract of odontogenic origin

Abstract

This is a case of a patient with a buccal cutaneous sinus tract, originally misdiagnosed, with delayed healing and potential malpractice. An odontogenic cutaneous sinus tract is a pathologic canal that initiates in the oral cavity but opens externally at the cutaneous surface of the face or neck. It is frequently misdiagnosed, leading to inappropriate treatment. Once correct diagnosis is made, definitive treatment, through oral therapy to eliminate the source of infection, is simple and effective. This case was initially misdiagnosed as a sebaceous cyst and laceration of parotid gland. The case was correctly diagnosed through detailed examination and evaluation, using tracing and advanced imaging technology (cone beam imaging). Endodontic treatment was performed, which resulted in rapid resolution of the case, followed by dermatologic treatment with fractional laser to treat the scar formed.

Odontogenic Cutaneous Fistula with Geminated Right Mandibular Second Molar: A Case Report

“…Also the pulp testing, percussion and periodontal probing can assist in making diagnosis. 8 These tracts are conventionally treated with antibiotics, but they may re-appear on withdraw of medications. So,it is important to eradicate the original source of infection.…”

Odontogenic cutaneous sinus tracts: A clinician's dilemma

“…OCST are often misdiagnosed and majority of the times these patients come to a dermatologist with a skin nodule, ulcer or scar and don't remember or give history of dental symptoms prior to the onset of skin lesions. [ 10 11 ] The differential diagnosis of such lesions includes foreign body reactions, pyogenic granuloma, squamous cell carcinoma, osteomyelitis, actinomycosis, basal cell carcinoma, salivary gland fistula, infected cyst and deep fungal infections. However, a high index of suspicion and prompt dental evaluation by dental panoramic radiography (orthopantomography), intraoral periapical radiographic examination, placement of a gutta-percha point, and dental computerized tomography and pulp vitality testing are important in diagnosis of OCST.…”

Odontogenic Cutaneous Fistula: A Diagnosis to be Remembered by the Dermatologist

“…1 Approximately 50% of the affected patients undergo multiple ineffective treatments (incision, drainage, and long-term antibiotics), due to improper diagnosis and lack of treatment of the dental infection. 4 The cutaneous portion of odontogenic sinus is typically a nontender, erythematous nodule or a small nodulocystic lesion but ulceration, dyschromia, minor dimples, and other features may occur. 5 Cords of tissue connecting the skin to the maxilla or mandible can be palpable and a pus-like discharge through the sinus opening may occur upon squeezing the cord.…”

“…3 The absence of pain in most patients along with previous treatment attempts with incision and drainage, progressing to scarring and atrophic lesions can contribute to the delaying the correct diagnosis. 3,4 The diagnosis is based on clinical suspicion and confirmed by a panoramic X-ray or especially by a periapical dental film, which show the radiolucency of the offending teeth. The panoramic radiograph can reveal partial alveolar bone loss due to pulpitis and the presence of a periapical tooth abscess.…”