Cutaneous sinus tracts (or emerging sinus tracts) of odontogenic origin: a report of 3 cases

Abstract

Three cases are presented in which patients presented with either cutaneous swelling or cutaneous sinus tracts of odontogenic origin. A cutaneous sinus tract of odontogenic origin is a pathway through the alveolar bone that typically begins at the apex of an infected tooth or of an infected portion of the dental alveolus and empties infected material (pus) through the skin. Where as the more common finding of an oral fistula is a pathway from the apical periodontal area of a tooth to the surface of the oral mucous membrane, permitting the discharge of suppurative material. Diagnosis, etiology and treatment are discussed with reference to patient history, clinical examinations, imaging, and treatment perspectives.

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“…Vicentii, orphyromonas gingivalis Veillonella parvula, Enterococcus faecalis, Campylobacter gracellis and Neisseria mucosa invade the tooth through the enamel and dentin, infecting the pulp causing necrosis, periodontitis and formation of the periapical abscess, rich in anaerobic bacteria. Usually this process is acute and renders the patient to seek medical attention [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. With the passing of time between six months and 30 years, added to the partial and temporal recovery, symptoms may be masked meanwhile the infectious process continues and intensifies, becoming chronic.…”

“…Only 50% of the patients feel pain or dental sensitivity, but there may be evident drainage which can produce esthetic problems [19]. The most common fistulas are associated with mandibular teeth in 80 to 87% of the cases, in a proportion of 4:1 between mandibular and maxillary unions and more common in anterior dental pieces like canine or incisor than posterior teeth [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. In other rare occasions it has been documented otherwise [13][14][15].…”

“…This last is rare, but easily misdiagnosed due to the amount of differential diagnoses which may be mistaken, for so patients could undergo unnecessary antibiotic therapy, allowing the infection to be chronic [3,4]. Fortunately, life threatening complications such as osteomyelitis and sepsis are not very common [5,6]. Whenever a patient has a facial o cervical fistula, it is mandatory a complete oral exploration looking for an odontogenic abscess besides a fibrous tissue (fistula) on the mandibular angles, cheeks or chin that connects jugal with gingival mucosa, causing the skin retraction [7][8][9].…”

Fistule cutanée d’origine dentaire : recherche de la dent causale

“…La fistule siège dans la région génienne basse, en regard de la 36 mortifiée et le cône de repérage se dirige vers la région de la furcation. Selon Slutzky-Goldberg et al [11] et Brown et al [12], dans 71 % des cas, la fistule cutanée est secondaire à un foyer infectieux d'origine endodontique. L'amputation de la racine mésiale de la 36 qui présente une obturation insuffisante, a été décidée en l'absence d'évolu-tion favorable dans le délai habituel, normalement entre 5 et 15 jours après l'élimination du foyer infectieux périapi-cal [13].…”

A Case of Intermittently Discharging Skin Lesion: Orodentocutaneous Fistula Demonstrated on CT Fistulography

“…Common conditions leading to formation of cutaneous sinuses include suppurative dental infection, osteomyelitis, infected cyst, tubercular or fungal infections or congenital fistula [2][3][4].…”