DIAGNOSIS AND TREATMENT OF CUTANEOUS FACIAL SINUS TRACTS OF DENTAL ORIGIN

doi:10.14219/jada.archive.1999.0307

The Journal of the American Dental Association

Volume 130, Issue 6, June 1999, Pages 832-836

https://doi.org/10.14219/jada.archive.1999.0307 Get rights and content

ABSTRACT

Background

Cutaneous draining sinus tracts of dental origin often are a diagnostic challenge. A delay in correctly diagnosing these types of lesions can result in ineffective and inappropriate treatment.

Case Description

The authors present five cases of facial lesions that were initially misdiagnosed as lesions of nonodontogenic origin. The correct diagnosis in each case was cutaneous sinus tract secondary to pulpal necrosis and suppurative apical periodontitis. All facial sinus tracts resolved after the patients received nonsurgical root canal therapy.

Clinical Implications

As patients with cutaneous facial sinus tracts of dental origin often do not have obvious dental symptoms, possible dental etiology may be overlooked. Early correct diagnosis and treatment of these lesions can help prevent unnecessary and ineffective antibiotic therapy or surgical treatment.

REFERENCES (10)

McWalterGM et al.
Cutaneous sinus tracts of dental etiology
Oral Surg Oral Med Oral Pathol
(1988)
BraunRJ et al.
A dermatologic lesion resulting from a mandibular molar with periradicular pathosis
Oral Surg Oral Med Oral Pathol
(1981)
ScottMJ et al.
Cutaneous odontogenic sinus
J Am Acad Dermatol
(1980)
CioffiGA et al.
Cutaneous draining sinus tract: an odontogenic etiology
J Am Acad Dermatol
(1986)
SpearKL et al.
Sinus tracts to the chin and jaw of dental origin
J Am Acad Dermatol
(1983)

There are more references available in the full text version of this article.

Cited by (75)

An asymptomatic draining lesion on the cheek
2020, JAAD Case Reports
Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin
2019, Journal of Endodontics
The detection of a tooth with a sinus tract (ST) of endodontic origin and its pathway are conventionally assessed with a periapical radiograph and a gutta-percha cone introduced into its stoma. The aim of this study was to evaluate the possibility to detect STs and trace their route using ultrasound real-time examination.
Two calibrated examiners performed echography on 10 patients who had a lesion of apical periodontitis (AP) and ST and 10 patients in the control group with AP without an ST recruited in 2 endodontic practices. They also traced the pattern of the STs with a computer program. The images were then submitted to 2 calibrated and blinded observers who were asked to describe the presence of AP and ST and to trace it with the same program. The data obtained were compared with the clinical and radiographic diagnosis of ST. For sensitivity, specificity, accuracy, and positive and negative predictive values, the receiver operating characteristic curve and Fisher exact test were used (P < .05).
Interobserver agreement was high as was the diagnostic accuracy of the ultrasound examination of STs (mean value = 97.5%), and the Fisher exact test showed statistical significance (P < .05). High sensitivity and a negative predictive value and 100% specificity and a positive predictive value were also obtained. The application of the 3-dimensional mode further enabled the reconstructions of the more complex paths, and the implementation with color power Doppler disclosed the vascularity surrounding the STs.
The ultrasound examination is a technique feasible to describe and trace the STs of endodontic origin.
Cone-beam Computed Tomography as a Noninvasive Assistance Tool for Oral Cutaneous Sinus Tract Diagnosis: A Case Series
2019, Journal of Endodontics
Citation Excerpt :
When a patient with an extraoral lesion arrives at the dental clinic, the origin of the lesion should be identified8,17. The recommendation in the literature is a tracing X-ray after insertion of a lacrimal probe or a sharp-tipped wire into the orifice opening, which will pass through the ST path until resistance is felt4,6,9,20–23. This diagnostic procedure has several disadvantages, including possible damage to the tissue of odontogenic or nonodontogenic lesions, discomfort of the patient, and stress of the operator9.
An oral cutaneous sinus tract is a relatively uncommon condition that is generally associated with long-standing periapical inflammation. The traditional process of oral cutaneous sinus tract diagnosis is an invasive method based on the insertion of a lacrimal probe or wire. The present article describes the use of cone-beam computed tomographic imaging as a noninvasive assistant tool for the verification of the odontogenic origin.
Oral Appliances in Obstructive Sleep Apnea
2016, Otolaryngologic Clinics of North America
Citation Excerpt :
Advanced dental decay can result in the devitalization of the pulp chamber, which can in turn lead to pain that is exacerbated by tapping the affected tooth with a mirror handle or similar instrument. These necrotic chambers often drain to the buccal and lingual surfaces, resulting in a draining fistula adjacent to the affected root (Fig. 2).30 The use of a removable oral appliance can lead to increased tooth decay by acting as a new retentive surface for the colonization of Streptococcus mutans and other cariogenic bacteria.31
Odontogenic cutaneous fistula: Report of a case that simulates an epidermal cyst and a literature update
2016, Piel
Periapical Cyst Forming Cutaneous Sinus Tract: Unusual Presentation—Case Report
2024, Indian Journal of Otolaryngology and Head and Neck Surgery

View all citing articles on Scopus

¹: Dr. Johnson is a clinical associate professor and director, Postdoctoral Endodontics, Department of Endodontics, University of Illinois at Chicago, College of Dentistry, M/C 642, 801 S. Paulina St., Chicago, Ill. 60612-7212.

²: Dr. Remeikis is a professor and head, Department of Endodontics, University of Illinois at Chicago, College of Dentistry.

³: Dr. Van Cura was director, Postdoctoral Endodontics, Department of Endodontics, University of Illinois at Chicago, College of Dentistry, when the patients in the cases were seen. He now is in private practice, Berwyn, Ill.

View full text

Case ReportsDIAGNOSIS AND TREATMENT OF CUTANEOUS FACIAL SINUS TRACTS OF DENTAL ORIGIN

ABSTRACT

Background

Case Description

Clinical Implications

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Case Reports
DIAGNOSIS AND TREATMENT OF CUTANEOUS FACIAL SINUS TRACTS OF DENTAL ORIGIN