Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin

Abstract

Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.

November’s 2020 Full Issue PDF

“…Odontogenic cutaneous sinus tract can be termed as "chronic periapical abscess with an extraoral sinus opening 13 ". Metzger et al applied a similar term, "a chronic apical abscess, " describing the origin of OCST.…”

“…Literature also allocates such forms of skin lesion appearances of the OCSTs like cutaneous infiltration 5,6 , suppurated nodule, 7 and even seventh form of manifestations-odontogenic cutaneous granuloma with fistula. 6 Trying to highlight a wide variety of descriptions of cutaneous part of the OCSTs, here are just a few of them: 1) erythematous, exophytic nodule with a crusted surface and a central stoma 13 , 2) puckered appearance on the skin 20 , 3) an erythematous, crusted nodule measuring about 50 mm with pus discharge 21 , 4) affected skin can be hyperemic or of a normal color, thinned, cyanotic, glossy, forms folds and unevenness 5,6 , 5) reddish abscess 2.5 cm in diameter 22 , 6) orocutaneous fistula 19 , 7) granuloma (ie, such type of cutaneous manifestation of OCST [not a pyogenic granuloma]) sizes are variable (from 1 to 3-4 cm) 5 , 8) classically, the lesion presented as an erythematous nodule of diameter up to 2 cm with or without drainage 23 , 9) nodulocystic cutaneous lesion 7 , 10) cutaneous fistula with hyperpigmented retracted skin 24 , etc.…”

“…Varghese et al notice: in some cases (when the cutaneous changes are reversible) endodontic treatment of the necrotic tooth alone can eliminate the need for surgery, and in other cases (when the cutaneous changes are irreversible) -at least such treatment can improve the condition of the tissues in area of cutaneous lesion. 13 Resolution of dimpling and hyperpigmentation is usually very slow and it can remain for a long time. So, the surgical revision may be needed for esthetic reasons.…”