Extraoral Sinus Tracts of Odontogenic Origin: A Case Series
Extraoral sinus tracts of odontogenic origin often develop as the result of misdiagnosis of persistent dental infections due to trauma, caries, or periodontal disease. Due to these lesions' imitation from cutaneous lesions, misdiagnosis, and mismanagement, which we frequently encounter, this article aims to describe four cases with manifestations in different parts of the face and the neck. Patients were referred to an endodontist with a history of several surgical procedures and/or antibiotic therapy due to misdiagnosis. After comprehensive examinations, root canal treatment was performed. The resolution of signs and symptoms during the follow-up period confirmed the correct diagnosis. Dermatologists and other physicians should be aware of the possibility of the relationship of extraoral sinus tracts with dental infections. Precise examination and taking a comprehensive history can aid to prevent unnecessary and incorrect therapeutic and/or pharmaceutical interventions. Elimination of dental infection leads to complete recovery in such patients.
2. Curvers F, De Haes P, Lambrechts P. Non-surgical endodontic therapy as treatment of choice for a misdiagnosed recurring extraoral sinus tract. Eur Endod J. 2017 Jan 1;2(1):13.
3. Glossary: Contemporary Terminology for Endodontics. American Association of Endodontists, 1994. Available at: https://www.endoexperience.com/documents/03GlossaryofEndoTerms_Web.pdf/ Accessed June 23, 2019.
4. Heling I, Rotstein I. A persistent oronasal sinus tract of endodontic origin. J Endod. 1989 Mar 1;15(3):132-4.
5. Gupta M, Das D, Kapur R, Sibal N. A clinical predicament—diagnosis and differential diagnosis of cutaneous facial sinus tracts of dental origin: a series of case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Dec 1;112(6):e132-6.
6. Johnson BR, Remeikis NA, Van Cura JE. Diagnosis and treatment of cutaneous facial sinus tracts of dental origin. J Am Dent Assoc. 1999 Jun;130(6):832-6.
7. Mittal N, Gupta P. Management of extra oral sinus cases: a clinical dilemma. J Endod. 2004 Jul 1;30(7):541-7.
8. Guevara‐Gutiérrez E, Riera‐Leal L, Gómez‐Martínez M, Amezcua‐Rosas G, Chávez‐Vaca CL, Tlacuilo‐Parra A. Odontogenic cutaneous fistulas: clinical and epidemiologic characteristics of 75 cases. Int J Dermatol. 2015 Jan;54(1):50-5.
9. Katou F, Motegi K. Congenital midline sinus of the upper lip: Report of a case. Int J Oral Maxillofac Surg. 1989 Aug 1;18(4):237-8.
10. Craig RM, Andrews JD, Wescott WB. Draining fistulas associated with an endodontically treated tooth. J Am Dent Assoc. 1984 May;108(5):851-2.
11. Goldstein BH, Sciubba JJ, Laskin DM. Actinomycosis of the maxilla: review of literature and report of case. J Oral Surg. 1972 May;30(5):362-6.
12. Purohit SD, Mathur BB, Gupta PR, Agarwal KC, Hathi HH. Tuberculous fistula of cheek: Report of a case. Oral Surg Oral Med Oral Pathol. 1985 Jul 1;60(1):41-2.
13. Mahler D, Joachims HZ, Sharon A. Cutaneous dental sinus imitating skin cancer. Br J Plast Surg. 1971 Jan 1;24:78-81.
14. Jacobs J, Shocket E. Dermal fistula of dental origin masquerading as a skin cancer: Report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol. 1965 Feb 1;19(2):184-7.
15. Yasui H, Yamagushi M, Lchimiya M, Yoshikawa Y, Hamamoto Y, Muto M. A case of cutaneous odontogenic sinus. J Dermatol. 2005;32:852-5.
16. Cioffi GA, Terezhalmy GT, Parlette HL. Cutaneous draining sinus tract: an odontogenic etiology. J Am Acad Dermatol. 1986 Jan 1;14(1):94-100.
17. Lee EY, Kang JY, Kim KW, Choi KH, Yoon TY, Lee JY. Clinical characteristics of odontogenic cutaneous fistulas. Ann Dermatol. 2016 Aug 1;28(4):417-21.
18. Cohenca N, Karni S, Rotstein I. Extraoral sinus tract misdiagnosed as an endodontic lesion. J Endod. 2003 Dec 1;29(12):841-3.
19. Pasternak‐Júnior B, Teixeira CS, Silva‐Sousa YT, Sousa‐Neto MD. Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: three case studies. Int Endod J. 2009 Mar;42(3):271-6.
20. Swales KL, Rudralingam M, Gandhi S. Extraoral cutaneous sinus tracts of dental origin in the paediatric patient. A report of three cases and a review of the literature. Int J Paediatr Dent. 2016 Sep;26(5):391-400.
21. Salamat K, Rezai RF. Nonsurgical treatment of extraoral lesions caused by necrotic nonvital tooth. Oral Surg Oral Med Oral Pathol. 1986 Jun 1;61(6):618-23.
22. Witherow H, Washan P, Blenkinsopp P. Midline odontogenic infections: a continuing diagnostic problem. Br J Plast Surg. 2003 Mar 1;56(2):173-5.
23. Soares JA, De Carvalho FB, Pappen FG, Araújo GS, De Pontes Lima RK, Rodrigues VM, et al. Conservative treatment of patients with periapical lesions associated with extraoral sinus tracts. Aust Endod J. 2007 Dec;33(3):131-5.
24. Gupta R, Hasselgren G. Prevalence of odontogenic sinus tracts in patients referred for endodontic therapy. J Endod. 2003 Dec 1;29(12):798-800.
25. Kar S, Bera S, Karmakar D. Comparative evaluation of the antibacterial efficacy of calcium hydroxide as an intracanal medicament and combination of calcium hydroxide with food preservatives and proton pump inhibitor against Enterococcus faecalis-an invitro study. Paripex Indian J Res. 2020 Jan 30;9(1). 10.36106/paripex/7300841.
26. Pannu R, Berwal V. Calcium Hydroxide in Dentistry: A Review. J Appl Dent Med Sci. 2017;3:3.
27. Agrawal V. Calcium hydroxide: A miracle munition. Indian J Dent Res Rev. 2011;1:16-8.
28. Hjeljord LG, Rölla G, Bonesvoll P. Chlorhexidine–protein interactions. J Periodont Res. 1973 Dec;8:11-6.
29. Emilson CG, Ericson T, Heyden G, Magnusson BC. Uptake of chlorhexidine to hydroxyapatite. J Periodont Res. 1973 Dec;8:17-21.
30. Hugo WB, Longworth AR. Some aspects of the mode of action of chlorhexidine. J Pharm Pharmacol. 1964 Oct;16(10):655-62.
31. Ghabraei S, Bolhari B, Sabbagh MM, Afshar MS. Comparison of Antimicrobial Effects of Triple Antibiotic Paste and Calcium Hydroxide Mixed with 2% Chlorhexidine as Intracanal Medicaments Against Enterococcus faecalis Biofilm. J Dent (Tehran). 2018 May;15(3):151-160.
32. Nag M, DivyaLalitha N, Manipal S, Bharathwaj VV, Prabu D. Chlorhexidine Loaded Calcium Hydroxide as a Potential Antimicrobial Intracanal Medicament–A Systematic Review. J Pharm Sci Res. 2019 Sep 1;11(9):3210-6.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.