Management of Extra Oral Sinus Cases: A Clinical Dilemma

BMJ Case Reports

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 si...

Journal of Endodontics, 2003

Journal of Evolution of Medical and Dental sciences, 2013

Chronic inflammation of the dental pulp is one of the reasons for cutaneous sinus tract of odontogenic origin. A cutaneous sinus or extra oral sinus from a lesion of endodontic origin is rare as compared to an intra oral sinus and may occur as result of long standing inflammatory process associated with necrotic pulp. Such patients are usually healthy and are unaware of the underlying asymptomatic dental problem. Common clinical presentation in these patients is a papule or nodule located most commonly in the chin, cheek or in submandibular area and this leads them to seek treatment from a general physician or a dermatologist. They may undergo unnecessary multiple biopsies, multiple surgical interventions, multiple antibiotic regimens, and even be subjected to radiation therapy or electrodessication. However more often than not, recurrence of sinus tract takes place because the primary dental etiology is never taken care of. The present article aims to report three cases of cutaneous sinus tracts in the submental area which were treated conservatively by endodontic treatment of the involved teeth.

Journal of Istanbul University Faculty of Dentistry, 2015

Clinically, extraoral sinus tracts of endodontic origin may be confused with a wide variety of diseases. Thus, the differential diagnosis of this clinical dilemma is of paramount importance in providing appropriate clinical care because misdiagnosis of this condition may result in healing failure or unnecessary treatments. For this reason, a dental cause must be considered for any cutaneous sinus tract involving the face or neck. Its diagnosis is not always easy unless the treating clinician considers the possibility of its dental origin. once the correct diagnosis is made, definitive treatment, through either tooth extraction or root canal therapy to eliminate the source of infection, is simple and effective.

IP Innovative Publication Pvt. Ltd., 2016

The cutaneous sinus tract of maxillary dental origin is a rare but, a well-documented condition. However, several non-odontogenic disorders may also produce an extra-oral sinus tract. The diagnosis is a perplexity unless the treating operator considers the occurent of its dental origin. Such patients may undergo multiple surgical excisions and antibiotic therapy, but the treatment fails with the recurrence of the lesion, because the primary etiology is misdiagnosed. This case report describes a non-surgical endodontic therapy performed in relation with right maxillary first molar (# 16) which was misdiagnosed earlier. The confirmatory diagnosis was made by injection of radio-opaque contrast followed by Cone-beam computed tomography (CBCT) scan. The condition was diagnosed as chronic periradicular abscess with # 16 draining to an extra oral cutaneous sinus tract opening in right malar region. A successful outcome is observed after non-surgical endodontic treatment during follow-up of five years.

Australian …, 2007

This paper describes the clinical courses of three cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. All teeth involved had periradicular radiolucent areas noted on radiographic examination and extra-oral sinus tracts appearing on the chin with exudation and unpleasant aesthetic appearance. The adopted treatment protocol included treating the sinus tract surface simultaneously with the root canal therapy. After root canal shaping using 5.25% sodium hypochlorite solution, calcium hydroxide-based pastes associated with different vehicles were inserted into the root canal for 4 months, and were changed monthly. All the sinus tracts healed in 7 to 10 days. The apical lesions were completely repaired in a maximum period of 24 months. The treatment adopted provided a complete healing of the periapical lesions in a short follow-up period. Surgical repair of the cutaneous sinus tract was therefore unnecessary.

Int. j. adv. multidisc. res. stud, 2024

Chronic inflammation of the dental pulp is one of the reasons for cutaneous sinus tract of odontogenic origin. A cutaneous sinus or extra oral sinus from a lesion of endodontic origin is rare as compared to an intra oral sinus and may occur as result of long-standing inflammatory process associated with necrotic pulp. Such patients are usually healthy and are unaware of the underlying asymptomatic dental problem. Thus, the treatment protocol should be elimination of the etiological factors first. A 24year-old male was presented with a draining sinus tract on his left cheek. In radiographic assessment, periapical lesion was noticed associated with the roots of the affected tooth. Root canal treatment was performed using Calcium hydroxide as an intracanal medicament. The sinus tract disappeared one weeklater. However, longterm clinical and radiological evaluation is necessary.

Dental, Oral and Craniofacial Research

Cutaneous odontogenic fistulas or sinus tracts are frequently misdiagnosed and incorrectly treated, leading to unnecessary procedures and patient suffering. An understanding of the draining of cutaneous sinus tracts will lead to more appropriate treatment [1]. Most cases respond to conservative, nonsurgical root canal therapy. Our objective is to report a case of cutaneous sinus tract evolving for 6 years secondary to chronic periapical dental infection caused by old trauma. The conservative treatment of the causal teeth was sufficient to achieve healing despite the oldness of the fistula.

International Dental & Medical Journal of Advanced Research - VOLUME 2015

Odontogenic extraoral, cutaneous sinus is described as a path leading from an enclosed area of inflammation to an epithelial surface. The patients visit a physician first for evaluation, diagnosis, and treatment and both do not give consideration most of the times to the dental etiology. The misdiagnosis and mismanagement leading to persistence of infection can cause frustration to the patient. Successful management of the odontogenic cutaneous sinus tracts of pulpal pathology depends on proper diagnosis. However, these lesions continue to be a diagnostic quandary. Two cases of 11-year-old and 13-year-old female patients with cutaneous extraoral sinus tract have been discussed in this article. These patients were not taken seriously by the physicians, and due to their negligence, these pediatric patients had to undergo a lot of trauma. The case report describes how after proper history, diagnosis, and correct treatment by a pedodontist, the infection healed in these two different patients. Proper diagnosis is the basic requirement for the successful management of the odontogenic cutaneous sinus tracts of pulpal origin. Several case reports reveal that the appropriate diagnosis could not be made leading the incorrect treatment offered to the patients. It causes the cutaneous sinus tract to reoccur as the dental etiology is not addressed. The cutaneous sinus tracts are a rare entity in the pedodontic patients. Proper management can lead to treatment at a much earlier stage thus curbing the progression of the disease and also saving of time and expenses of the patient.

Dental Traumatology, 1995

Abstract When a draining lesion is encountered on the skin of the face, an endodontic origin should always be considered in differential diagnosis. Non-surgical endodontic therapy, sometimes complimented by surgery, or extraction are the choices for the treatment of these cases. Three cases of extraoral sinus tract on the chin caused by necrotic pulp of traumatized lowrer anterior teeth are presented. A paste consisting of calcium hydroxide and barium sulfate powder mixed with glycerin was used. Usage of calcium hydroxide paste was advocated for rapid and successful treatment of extraoral lesions communicating with necrotic teeth.