Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata

Abstract

Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with sinus tract can be conservatively healed with endodontic treatment alone.

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

“…As reported in the literature, OCSTs are frequently misdiagnosed and as a consequence often mismanaged (Bashar et al, 2019;Swales et al, 2016). In addition, differential diagnosis is paramount in making an efficient constructive treatment plan.…”

<strong>Effectiveness of ChKM solution compared to triple-antibiotic paste as an intracanal medicament for bacteria that cause a chronic periapical abscess</strong>

“…Both have a similar mechanism of action. 13,14 Both ChKM solution and TAP are made up of several ingredients. TAP is more beneficial than the ChKM solution for periapical abscesses treatment since they do not require a combination of other intracanal medicaments.…”

Unusual presentation of an extraoral and multiple intraoral sinus tracts in a 6-year-old pediatric patient

“…Intraoral drainage is more common than extra oral drainage with the mandibular teeth being a more common source than the maxillary teeth. [ 1 2 ] Extra oral sinus tracts can be non-odontogenic and odontogenic in origin and often present a diagnostic challenge. Only 50% of the patients with facial cutaneous sinus tracts have tooth-related symptoms because of which, patients are often attended to by health care professionals other than dentists.…”

“…The differential diagnosis includes osteomyelitis, furuncle, congenital fistula, salivary gland fistula, deep mycotic infection, granulomatous disorder, pustule, myositis, foreign body lesion, infected cyst, suppurative lymphadenitis, and neoplasm. [ 1 2 3 ]…”

“…The unusual clinical presentation seen with respect to the primary molars in the present case is attributed to the delay in diagnosis due to asymptomatic teeth and multiple antibiotic therapies which blocked the drainage partially through incomplete healing. [ 1 ] It has been reported that permanent tooth buds in the line of infection may be expelled as foreign bodies through the extra oral sinus tract in which case the parent may complain of loss of a tooth through the extra oral sinus tract. [ 4 ] Inappropriate management like biopsy, curettage, antibiotic therapy, surgical excision of the cutaneous lesion, and radiotherapy may provide temporary relief but are inevitably followed by recurrence and compromised aesthetics due to skin scarring.…”