Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge

Abstract

Odontogenic cutaneous fistulas often lead to intense levels of patient discomfort and suffering. Due to its rarity and the absence of dental symptoms, a considerable number of patients are usually misdiagnosed which results in inappropriate management. This case report presents a 16-year-old patient with a 2-year history of a nonhealing, persistently discharging lesion in the left submandibular region of the neck. The patient underwent exploration of the left submandibular region, and a fistulous tract directed superomedially to the ipsilateral lower molar teeth was excised. A subsequent panoramic orthopantomogram performed one week postoperatively demonstrated radiolucency is the distal root of tooth 37. A final diagnosis of odontogenic cutaneous fistula was made, and the patient was referred to the Maxillofacial Department for treatment of the offending tooth.

Odontogenic Cutaneous Fistula with Geminated Right Mandibular Second Molar: A Case Report

“…However these symptoms are alleviated once this purulent material made its way out. 6 Patients often do not have obvious history of toothache therefore these tracts are often misdiagnosed due to their rarity. 7 So it is important to make correct diagnosis in order to start treatment timely and prevent any complication.…”

Odontogenic Cutaneous Fistula: A Diagnosis to be Remembered by the Dermatologist

“…The variability of morphological presentations and locations of the cutaneous lesions coupled with the lack of knowledge that such a condition can have a dental etiology generally leads to the misdiagnoses by surgeons and dermatologists, leading to unnecessary antibiotic and surgical therapies. 1 Approximately 50% of the affected patients undergo multiple ineffective treatments (incision, drainage, and long-term antibiotics), due to improper diagnosis and lack of treatment of the dental infection. 4 The cutaneous portion of odontogenic sinus is typically a nontender, erythematous nodule or a small nodulocystic lesion but ulceration, dyschromia, minor dimples, and other features may occur.…”

“…The chronic process slowly evolves through the cancellous alveolar bone, following the path of least resistance until it perforates the cortical plate of the mandible, spreading to the surrounding soft tissues and erupting on the skin. 1 Dental treatment is the mainstay of therapy: endodontic treatment or surgical root canals and apicoectomies for restorable teeth and extraction of non-vital teeth can eliminate infection. The sinus tract will typically resolve within 5 to 20 days, while minimal scarring and hyperpigmentation can remain.…”

“…An odontogenic cutaneous fistula (OCF) is one of the many consequences of chronic dental infection and it is defined as an abnormal communication between the face and the oral cavity, mostly due to a dental lesion. 1 It is a rare and often misdiagnosed condition, leading inappropriate treatment and recurrence. The causes include caries, pulp infection, periapical/ periodontal diseases, root fracture, and chemical/mechanical trauma.…”

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“…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.…”