Odontogenic Sinus Tract to the Neck Skin: A Case Report

Abstract

We describe a 22-year-old woman with neck skin sinus tract that developed as a consequence of dental infection. The patient was treated twice in an inappropriate way with recurrence of the sinus tract. We opted for an extraction of the tooth. This case illustrates the need for cooperative diagnostic referrals between physicians and dentists.

Treatment of Extraoral Cutaneous Sinus Tracts With Non-Surgical Endodontic Intervention: Report of Six Cases

“…Differential diagnosis of cutaneous draining sinus tract should include suppurative apical periodontitis, osteomyelitis, traumatic lesions, congenital fistula, salivary gland fistulas and infected cyts, deep mycotic infections and gumma of tertiary syphilis. In addition, skin lesions such as pustules and furuncles, foreign-body lesions, squamous cell carcinoma and granulomatous disorders may all be similar superficially in appearance to draining sinus tracts of dental origin, but they are not true sinus tracts ( 1 , 2 , 4 , 6 , 7 , 12 , 14 , 18 ).The principle of managing such lesions is to remove the source of dental infection ( 9 , 14 , 16 ). Unless the dental focal infection is treated, recurrence is likely ( 5 , 10 ).…”

“…Clinically, these lesions appear as a papule or nodule, 1 mm to 20 mm in diameter with purulent discharge, usually on the chin or in the submental region ( 1 , 3 , 4 , 7 , 16 , 18 ). The other uncommon locations are cheek, canine space, nasolabial fold, nostrils, neck and inner canthus of eye ( 5 , 7 , 9 , 17 , 18 ). Palpation of the involved area often reveals a cordlike tract attached to the underlying alveolar bone in the area of suspected tooth.…”

“…This rare entity is a pathway through the alveolar bone, which typically begins at the apex of an infected tooth or of an infected segment of the dental alveolus. It drains infected material (pus) through the skin ( 6 , 7 , 8 , 9 ). The site of a sinus tract depends on the location of the perforation in the cortical plate by the inflammatory process and its relationship to facial-muscle attachments ( 6 , 10 ).…”

“…Although cutaneous sinus tracts of dental origin have been previously documented, these lesions still present diagnostic challenges. As the lesion develops, it is usually not thought to be of dental origin and the patients seek treatment from dermatologists, a family physician or a general surgeon, often undergoing multiple antibiotic regimens, surgical excisions, biopsies and even radiotherapy ( 9 , 11 , 12 , 14 , 16 , 17 , 18 ). Misdiagnosis adds to the chronicity of the lesion and has profound effects on facial esthetics due to unnecessary treatments resulting in cutaneous scarring and dimpling ( 3 , 5 , 6 , 7 , 10 ).…”

Non surgical management of cutaneous sinus tract of odontogenic origin: A case report

“…Cutaneous odontogenic sinus tracts of dental origin are uncommon. Although they have been well documented in the medical and dental literature, these lesions continue to be often misdiagnosed, challenging and pose a diagnostic dilemma (Cohenca et al, 2003;Susic et al, 2004). Studies revealed that the extra-oral sinus tracts are most commonly found on the cheek, chin and angle of the mandible (Slutzky-Goldberg et al, 2009;Magliocca et al, 2010;Vyas and Chaturvedi, 2011).…”