Cutaneous sinus tracts of dental origin

Extraoral cutaneous sinus tracts of dental origin in the paediatric patient. A report of three cases and a review of the literature

“…The aetiology of an extraoral sinus tract of odontogenic origin within the face and neck region has been cited as resulting primarily as result of caries and subsequent pulpal necrosis [1][2][3][4][5][6][7][8]11,14 , secondarily as a consequence of trauma-related pulpal necrosis 1,4,5,[10][11][12][13]15 and rarely, as a result of a periodontal infection 13,15 . In the case of odontogenic-related extraoral sinus lesions, the infection is usually chronic in nature and therefore presentation is delayed 4 often resulting in misdiagnosis of the causative factor [1][2][3][4][5][6][7][8][9][10]16,17 .…”

“…The odontogenic infection might initially be localized and present as a periapical or peri-odontal abscess [1][2][3][5][6][7][8][9][10][11][12][14][15][16][18][19][20] before spreading into the surrounding tissues. The sequelae of the resulting infection will depend on (i) the regional anatomy, (ii) virulence of the bacteria, and (iii) host resistance factors [1][2][3][5][6][7][8][10][11][12]21 .…”

“…In the case of extraoral sinus tracts, the infection can spread diffusely beyond the confines of the oral cavity into the surrounding tissues through the fascial planes along the path of least resistance 1,2,5,6,11,19 . The position of the affected tooth and the root apex location in terms of anatomy will determine the likely appearance of the infection as an intra-or extraoral presenting sinus 1,3,5,[10][11][12]19 . In the maxilla, swelling will initially present to the upper half of the face and may drain extraorally if the infection perforates the outer cortical plate.…”

“…Extraoral cutaneous sinus tracts of odontogenic origin can unfortunately often be misdiagnosed due to the unexpected appearance of the lesion without historic odontogenic pain, discomfort, or cellulitis [1][2][3][4][5][6][7][8][9][10][11]16,17 . The clinician must ensure that a thorough and careful history is obtained to aid diagnosis when a paediatric patient presents with an extraoral swelling [5][6][7]12,16,18 .…”

“…Special investigation in the form of radiographic examination of the dentition and the affected area is indicated, to confirm or refute odontogenic infection being the origin of an externally draining sinus 1,2,4,[6][7][8][9][10]12,16,17 . Sensibility testing should also be performed as an adjunct to both visual and radiographic inspection to assist diagnosis 1,2,[4][5][6][7][8]16,18 .…”