Cutaneous Sinus Tracts of Odontogenic Origin: Two Case Reports

Abstract

Background: Cutaneous odontogenic fistulas or sinus tracts are frequently misdiagnosed and incorrectly treated, leading to unnecessary procedures and patient suffering. An understanding of the draining of cutaneous sinus tracts will lead to more appropriate treatment. Most cases respond to conservative, nonsurgical root canal therapy. Our objective is to report 2 cases of cutaneous sinus tract secondary to chronic periapical dental infection that were recently observed at our hospital.Methods: We present 2 cases of recurrent suppurative facial lesions that were initially misdiagnosed and treated with oral antibiotics without response.Results: Clinical findings included palpable facial nodules with drainage, palpable intraoral cords, and poor dentition with gingivitis; radiologic examination showed a periapical disease process consistent with dental sinus tracts. Both of the cases were referred to the maxillofacial department, where the cyst and nonrestorable teeth were extracted.Conclusion: Because patients with cutaneous facial sinus tracts of dental origin often do not have obvious dental symptoms, a possible dental etiology may be overlooked. If dental origin is suspected, the diagnosis is easily confirmed by dental examination and dental roentgenograms of the involved area.

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“…Ultrasonography and CAT scans may be useful, but not necessary for diagnostics. 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].…”

“…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.…”

“…The purulent material tries to find a way out through a place that presents less resistance, in order to relieve the pain and the edema, the purulent material does this by passing through the periodontal ligament, bone and soft tissue right into the epidermis, creating an abscess o cellulites of the skin, which leads to a hole in the skin [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Besides cavities being the most common cause of periapical infection, there can be other causes such as trauma, root retentions, odontogenic cysts or chronic mandibular infections that lead to odontocutaneous fistulas [24]. Clinically, there can be a soft nodule on the skin, symmetric, erythematous, or covered with scab tissue, the skin can be retracted because of a fibrous tissue that joins the jugal mucosa with the gingival tissue, which if it is palpated may produce the exit of purulent material.…”

Treatment of odontogenic cutaneous sinus tract misdiagnosed for 6 years

“…An understanding of the draining of cutaneous sinus tracts will lead to more appropriate treatment [1]. Most cases respond to conservative, nonsurgical root canal therapy.…”

New Tools and Approaches for Family Physicians

“…Han and Tran 15 provide a comprehensive review of current guidelines for managing chronic hepatitis B. Giménez-García et al 16 teach us about chronically draining sinus tracts of the face with dental origins. Patients with this condition could easily present first to a family physician.…”