Submental cutaneous sinus tract of mandibular second molar origin

Abstract

An odontogenic origin should be part of the differential diagnosis for orofacial skin lesions. Cutaneous sinus tracts of mandibular molar origin are complex and thus a comprehensive examination should be stressed. It is necessary to examine all mandibular teeth in cases of odontogenic submental cutaneous sinus tracts. Sinus tract angiography can be used to identify the sinus tract pathway and to confirm the associated teeth. The treatment of an odontogenic cutaneous sinus tract requires the elimination of the source of infection.

Non-Surgical Endodontic Therapy as Treatment of Choice for a Misdiagnosed Recurring Extraoral Sinus Tract

“…Some authors used CT to visualise the path of the sinus in the soft tissues, but only Tian et al (23) used CBCT in the follow up of this pathology (24,25).…”

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“…The maxillary incisors will most likely drain into the base of the nose and the canine into the internal part of the eye. There are less cases with drainage sites located distant to the affected area such as chest, muscles and sacral region [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The diagnosis of a fistula requires suspicion, a well done medical history and an adequate physical and oral examination and sensitivity test.…”

“…Ultrasonography and CAT scans may be useful, but not necessary for diagnostics. If the biopsy material was sent to the lab the findings would be granulomatous tissue, pseudoepitheliomatous hyperplasia and chronic inflammation [23][24][25][26]. Usually it can misguide the diagnostics, as there are other entities that can generate fistulas, pyogenic granuloma, salivary gland fistulas, congenital fistulas, infected cysts, deep mycosis infections, actinomycosis, thyroid cyst, pustules, furuncles, reactions to foreign bodies, skin carcinomas such as basal cell and squamous cancer, inverted follicular keratosis, dacryocystitis, suppurative lymphadenitis, tertiary syphilis and tuberculosis [27,28].…”

Dental Sinus Infections- why are we still missing the well documented diagnosis?

“…They undergo multiple surgical excisions or biopsies which cause unnecessary scarring, further courses of antibiotic therapy, and even occasional radiotherapy with eventual recurrence of the cutaneous sinus tract and all because the primary dental cause is frequently misdiagnosed. However, if the correct diagnosis of the sinus tract is identified, the problem can be managed with a simple and effective treatment that comprises removal of the infected pulp canal tissue, which subsequently results in minimal cutaneous scarring (2,3,5,6,(8)(9)(10).…”