Diagnosis and Treatment of Odontogenic Cutaneous Sinus Tracts in an 11-Year-Old Boy

Abstract

Odontogenic cutaneous sinus tracts (OCSTs) are generally primarily misdiagnosed and inappropriately treated by virtue of their rarity and the absence of dental symptoms. Accurate diagnosis and treatment and the elimination of the source of infection can reduce the incidence of complications and relieve the pain of the patient.In this case report, we present the case of an 11-year-old patient with an apparent abscess but an unobvious draining sinus tract in his left cheek. Intraorally, a glass-ionomer-cement filling on the occlusal surface of the left mandibular first molar (tooth 36) was noted. Radiographic examination revealed a radiopaque mass inside the crown and pulp chamber and an irregular, radiolucent periapical lesion surrounding the distal root apex. He was diagnosed with an OCTS secondary to a periapical abscess of tooth 36. Precise root canal therapy (RCT) and chronic granuloma debridement was performed; 6 months later, the abscess and sinus had healed completely, and the periapical lesion had resolved.Odontogenic cutaneous sinus tracts are uncommon in the clinic. This case report reminds us of the significance of OCSTs and provides some implications for their diagnosis and treatment.

Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge

“…In the case presented, the clinical diagnosis of an odontogenic cutaneous fistula was achieved postoperatively. The diagnosis was elusive in the absence of carious teeth and an unremarkable dental history, a clinical phenomenon reported in 50% of patients [ 4 , 8 – 10 ]. The diagnostic conundrum was compounded by the location of the dental infection to the fistulous aperture and its variability [ 1 , 3 , 9 ].…”

“…Cone beam CT is unmatched when plane radiography is equivocal or inefficient in determining the extent and the relations of the periapical lesion with the adjacent teeth [ 2 , 8 ]. Fistulography via X-ray or CT using a gutta-percha usually provides the diagnosis when all other modalities fail [ 2 , 4 ]. Several authors describe treatment as removing the original source of infection by means of endodontic or extraction therapy with spontaneous closure of the fistulous tract within as much as 2 weeks [ 1 , 2 , 8 , 10 ].…”

“…Several authors describe treatment as removing the original source of infection by means of endodontic or extraction therapy with spontaneous closure of the fistulous tract within as much as 2 weeks [ 1 , 2 , 8 , 10 ]. Notably, surgical revision or fistulectomy is usually reserved for those cases whose fistulous tracts fail to terminate and those patients with aesthetically unpleasant hyperpigmented scared tissue [ 3 , 4 , 9 ]. In this case, the fistula's aperture seemed to be in close proximity to the distribution of marginal mandibular branch of the facial nerve.…”

“…Misdiagnosis and inappropriate treatment are common for odontogenic cutaneous fistulas due to its rarity and lack of dental symptoms [ 4 , 5 ]. The expansive differential diagnosis such as epidermal cysts, furuncle, carbuncle, branchial cleft fistula, pyogenic granuloma, salivary gland fistula, actinomycosis, thyroglossal tract fistula, basal cell and squamous cell carcinoma, osteomyelitis, and foreign body reaction further compound the diagnostic dilemma [ 5 ].…”

Odontogenic cutaneous sinus tract - misdiagnosis and follow-up in a seven-year-old boy

“…Odontogenic cutaneous sinus tracts (OCSTs), uncommon and therefore frequently misdiagnosed, are generally caused by chronic endodontic infections (Chen et al, 2016;Chouk & Litaiem, 2020). Patients presenting with OCSTs are often treated incorrectly with systemic antibiotics or surgical procedures by physicians because the dentition is often asymptomatic.…”