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A 50-year-old man was referred to dental hospital from the general surgery department in January 2012, with a 10-month history of draining lesion on left cheek (Figure 1). He had seen many different doctors, including physicians, dermatologists, general surgeons and plastic surgeons before reporting to our hospital. He had been given antibacterial, antifungal and topical corticosteroid treatment. He had also undergone surgical intervention twice. He also reported history of pain with molar tooth on the same side few years back. Physical examination was normal apart from skin lesion.

Figure 1: Cutaneous lesion on the face.

c

A Cone Beam Computed Tomography (CBCT) after injecting a radio-opaque contrast in the lesion was performed (Figure 2). CBCT showed that contrast travelled from cutaneous surface to roots of molar tooth in maxilla. The condition was diagnosed as chronic suppurative odontogenic infection with facial cutaneous sinus tract.

Figure 2: Reconstructed image of CBCT confirming dental involvement.

c

We treated our patient with root canal treatment (removal of infected pulp of tooth). At a six-year follow-up in January 2018, the patient is doing well, with no cutaneous drainage. The lesion has healed with a minor scar formation (Figure 3).

Figure 3: At a six-year follow-up, the cutaneous lesion healed with a minimal scar formation.

c

Discussion

Cases of facial lesions of dental origin have been commonly reported in medical, dental and dermatology literature.1 They are frequently misdiagnosed due to wide differential diagnosis. Differential diagnosis includes actinomycosis, pustule, osteomyelitis, neoplasms, carbuncle, infected epidermoid cyst, pyogenic granuloma, chronic tuberculosis, salivary gland fistula and gumma of tertiary syphilis.2 The correct diagnosis of such lesions should be suspected by gross appearance of lesion. They present as erythematous, smooth and non-tender lesions of 1mm to 20mm in diameter, with crusty and periodic drainage in most cases. Patient may present with history of dental pain or trauma few years back. Of all such cases, approximately 80% are mandibular and 20% are maxillary in origin.3 A simple dental procedure like root canal therapy or extraction of involved tooth may lead to successful outcome.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Pallav Mahesh Patni, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India;-Vinod Bhandari, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India; - Mahak Bhandari, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India; Bhandari Hospital & Research Center, Indore, MP, India; Swadhin Raghuwanshi, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India.-

Acknowledgements

The authors acknowledge Dr Manjushree Bhandari, Chairperson, SAIMS towards their guidance in preparation of this manuscript.

Correspondence

Dr Pallav Mahesh Patni, Professor, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India.

Correspondence Email

pallavpatni@yahoo.com

Competing Interests

Nil.

  1. Patni PM, Jain P, Patni MJ. Cutaneous sinus tract of dental origin. Postgrad Med J. 2016; 92:625.
  2. Shobatake C, Miyagawa F, Fukumoto T, Hirai T, Kobayashi N, Asada H. Usefulness of ultrasonography for rapidly diagnosing cutaneous sinus tracts of dental origin. Eur J Dermatol. 2014; 24:683–7.
  3. Giménez-García R, Martinez-Vera F, Fuentes-Vera L. Cutaneous Sinus Tracts of Odontogenic Origin: Two Case Reports. J Am Board Fam Med. 2015; 28:838–40.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 50-year-old man was referred to dental hospital from the general surgery department in January 2012, with a 10-month history of draining lesion on left cheek (Figure 1). He had seen many different doctors, including physicians, dermatologists, general surgeons and plastic surgeons before reporting to our hospital. He had been given antibacterial, antifungal and topical corticosteroid treatment. He had also undergone surgical intervention twice. He also reported history of pain with molar tooth on the same side few years back. Physical examination was normal apart from skin lesion.

Figure 1: Cutaneous lesion on the face.

c

A Cone Beam Computed Tomography (CBCT) after injecting a radio-opaque contrast in the lesion was performed (Figure 2). CBCT showed that contrast travelled from cutaneous surface to roots of molar tooth in maxilla. The condition was diagnosed as chronic suppurative odontogenic infection with facial cutaneous sinus tract.

Figure 2: Reconstructed image of CBCT confirming dental involvement.

c

We treated our patient with root canal treatment (removal of infected pulp of tooth). At a six-year follow-up in January 2018, the patient is doing well, with no cutaneous drainage. The lesion has healed with a minor scar formation (Figure 3).

Figure 3: At a six-year follow-up, the cutaneous lesion healed with a minimal scar formation.

c

Discussion

Cases of facial lesions of dental origin have been commonly reported in medical, dental and dermatology literature.1 They are frequently misdiagnosed due to wide differential diagnosis. Differential diagnosis includes actinomycosis, pustule, osteomyelitis, neoplasms, carbuncle, infected epidermoid cyst, pyogenic granuloma, chronic tuberculosis, salivary gland fistula and gumma of tertiary syphilis.2 The correct diagnosis of such lesions should be suspected by gross appearance of lesion. They present as erythematous, smooth and non-tender lesions of 1mm to 20mm in diameter, with crusty and periodic drainage in most cases. Patient may present with history of dental pain or trauma few years back. Of all such cases, approximately 80% are mandibular and 20% are maxillary in origin.3 A simple dental procedure like root canal therapy or extraction of involved tooth may lead to successful outcome.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Pallav Mahesh Patni, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India;-Vinod Bhandari, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India; - Mahak Bhandari, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India; Bhandari Hospital & Research Center, Indore, MP, India; Swadhin Raghuwanshi, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India.-

Acknowledgements

The authors acknowledge Dr Manjushree Bhandari, Chairperson, SAIMS towards their guidance in preparation of this manuscript.

Correspondence

Dr Pallav Mahesh Patni, Professor, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India.

Correspondence Email

pallavpatni@yahoo.com

Competing Interests

Nil.

  1. Patni PM, Jain P, Patni MJ. Cutaneous sinus tract of dental origin. Postgrad Med J. 2016; 92:625.
  2. Shobatake C, Miyagawa F, Fukumoto T, Hirai T, Kobayashi N, Asada H. Usefulness of ultrasonography for rapidly diagnosing cutaneous sinus tracts of dental origin. Eur J Dermatol. 2014; 24:683–7.
  3. Giménez-García R, Martinez-Vera F, Fuentes-Vera L. Cutaneous Sinus Tracts of Odontogenic Origin: Two Case Reports. J Am Board Fam Med. 2015; 28:838–40.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 50-year-old man was referred to dental hospital from the general surgery department in January 2012, with a 10-month history of draining lesion on left cheek (Figure 1). He had seen many different doctors, including physicians, dermatologists, general surgeons and plastic surgeons before reporting to our hospital. He had been given antibacterial, antifungal and topical corticosteroid treatment. He had also undergone surgical intervention twice. He also reported history of pain with molar tooth on the same side few years back. Physical examination was normal apart from skin lesion.

Figure 1: Cutaneous lesion on the face.

c

A Cone Beam Computed Tomography (CBCT) after injecting a radio-opaque contrast in the lesion was performed (Figure 2). CBCT showed that contrast travelled from cutaneous surface to roots of molar tooth in maxilla. The condition was diagnosed as chronic suppurative odontogenic infection with facial cutaneous sinus tract.

Figure 2: Reconstructed image of CBCT confirming dental involvement.

c

We treated our patient with root canal treatment (removal of infected pulp of tooth). At a six-year follow-up in January 2018, the patient is doing well, with no cutaneous drainage. The lesion has healed with a minor scar formation (Figure 3).

Figure 3: At a six-year follow-up, the cutaneous lesion healed with a minimal scar formation.

c

Discussion

Cases of facial lesions of dental origin have been commonly reported in medical, dental and dermatology literature.1 They are frequently misdiagnosed due to wide differential diagnosis. Differential diagnosis includes actinomycosis, pustule, osteomyelitis, neoplasms, carbuncle, infected epidermoid cyst, pyogenic granuloma, chronic tuberculosis, salivary gland fistula and gumma of tertiary syphilis.2 The correct diagnosis of such lesions should be suspected by gross appearance of lesion. They present as erythematous, smooth and non-tender lesions of 1mm to 20mm in diameter, with crusty and periodic drainage in most cases. Patient may present with history of dental pain or trauma few years back. Of all such cases, approximately 80% are mandibular and 20% are maxillary in origin.3 A simple dental procedure like root canal therapy or extraction of involved tooth may lead to successful outcome.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Pallav Mahesh Patni, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India;-Vinod Bhandari, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India; - Mahak Bhandari, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India; Bhandari Hospital & Research Center, Indore, MP, India; Swadhin Raghuwanshi, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India.-

Acknowledgements

The authors acknowledge Dr Manjushree Bhandari, Chairperson, SAIMS towards their guidance in preparation of this manuscript.

Correspondence

Dr Pallav Mahesh Patni, Professor, Department of Conservative Dentistry and Endodontics, Sri Aurobindo College of Dentistry (SAIMS) and Hospital, Madhya Pradesh Medical Science University, Indore, MP, India.

Correspondence Email

pallavpatni@yahoo.com

Competing Interests

Nil.

  1. Patni PM, Jain P, Patni MJ. Cutaneous sinus tract of dental origin. Postgrad Med J. 2016; 92:625.
  2. Shobatake C, Miyagawa F, Fukumoto T, Hirai T, Kobayashi N, Asada H. Usefulness of ultrasonography for rapidly diagnosing cutaneous sinus tracts of dental origin. Eur J Dermatol. 2014; 24:683–7.
  3. Giménez-García R, Martinez-Vera F, Fuentes-Vera L. Cutaneous Sinus Tracts of Odontogenic Origin: Two Case Reports. J Am Board Fam Med. 2015; 28:838–40.

Contact diana@nzma.org.nz
for the PDF of this article

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