Facial sinuses of dental origin

Rare periodontal ligament drainage for periapical inflammation of an adjacent tooth: a case report and review of the literature

Aim. To report a case with an unusual drainage route of periapical inflammation exiting through the gingival sulcus of an adjacent vital tooth and review probable factors determining the diversity of the discharge routes of periapical inflammation. Summary. An 18-year-old male patient presented with periodontal abscess of tooth 46, which was found to be caused by a periapical cyst with an acute abscess of tooth 45. During endodontic surgery, a rarely reported drainage route for periapical inflammation via the gingival sulcus of an adjacent vital tooth was observed for the first time. Complete periodontal healing of the deep pocket of tooth 46 and hiding of the periapical cyst of tooth 45 followed after root canal treatment and periapical surgery with Bio-Oss Collagen implantation on tooth 45. The drainage routes of periapical inflammation are multivariate and the diversity of drainage pathways of periapical inflammation is mainly related to factors such as gravity, barriers against inflammation, and the causative tooth itself.

Cutaneous sinus tract of dental origin in children-a report of 28 new cases

Little is known about the characteristics of cutaneous sinus tract (CST) of dental origin in children. 28 cases of CST of dental origin in children were evaluated. Age, sex, site of skin lesion, duration until diagnosis, teeth involved, etiology, treatment, and outcome were recorded. The last dental care visit was also recorded. The mean age was 10.25 years (range 4-16). The male to female ratio was 1:1.74. The mandibular-submandibular area was the most common site of skin lesions. The mandibular first molar was the most involved tooth, followed by the mandibular incisor. Caries was the most common etiology. The mean duration of lesions until correct diagnosis was 6.5 months (range 0.3-12 mos). The treatment was root canal therapy or extraction. After appropriate dental treatment, CSTs resolve rapidly. Surgical revision of the scars were indicated in eight (29%) patients, to provide better cosmetic results. In these patients, the duration of lesions were longer. Preventive dental care, as indicated by last dental care visit, was poor. CST in children is different from that in adults in terms of sites of skin lesions, duration of lesions, and involved tooth and similar to that in adults in terms of etiology and treatment modality. Early treatment of the dental infection may cause healing of the cutaneous lesion spontaneously, without a scar.

Patent odontogenic sinus tract draining to the midline of the submental region: report of a case

We report a case of a 65-year-old woman with a cutaneous sinus tract located on the midline of the submental region secondary to a periapical abscess of the right lateral mandibular incisor. The lesion was nodulocystic and chronically drained purulent fluid. Previous topical and systemic treatments were uneffective. Radiologic examination of the mandible demonstrated diffuse radiolucency involving the apices of four affected incisors. A further radiologic sinogram revealed both the exact origin and the high grade patency of the fistolous tract. Appropriate conservative endodontic therapy led to quick resolution of the sinus tract within sixteen days. In the presence of a single chronic suppurative or nodulocystic lesion of the face, it is always useful to perform a radiologic evaluation of the maxillary and mandibular regions to promptly exclude a possible odontogenic background.

Cutaneous draining sinus tract: an odontogenic etiology

Although the most common cause of the intermittently suppurating cutaneous sinus tract in the face and neck area is chronic dental infection, chronic draining sinus tracts of the face and neck continue to be a diagnostic challenge. The attending clinician must look carefully for a potential odontogenic infection; chronicity, lasting for weeks, months, and even years and the recognition of the lesion as a sinus tract are keys to making the correct diagnosis. Diagnostic errors can result in multiple surgical excisions and biopsies, long-term antibiotic therapy, and even radiation therapy or electrodesiccation. A review of 137 cases of cutaneous draining sinus tracts from the literature is presented, and four cases are reported. Conservative, nonsurgical root canal therapy is recommended as the first choice of treatment.

Cervicofacial sinuses

One hundred consecutive cases of cervicofacial sinuses are reviewed in terms of aetiology, diagnosis and subsequent management. One hundred and thirty-eight cases recorded in the world literature are reviewed for comparison.

Dental disease masquerading as suppurative lesions of the neck

Three female patients ages 16, 16, and 12, and an 8-yr-old male presented with neck pathology/2 with abscesses, 1 with a submandibular mass and 1 with a spontaneously draining abscess. In 2 instances, routine oral cavity examinations including percussion of the teeth, failed to reveal significant pathology. A detailed examination by a dentist, intraoral roentgenograms, and in the first child a sinogram, identified the etiology of the lesions as periapical infections. Review of the literature reveals that these patients characteristically receive multiple surgical procedures and courses of antibiotics prior to the recognition of intra-oral disease. Extraction, or root canal, is the definitive therapy that leads to involution of the sinus tract. These four typical cases are reported to illustrate the presentation and pathogenesis of this disease entity, and the importance of an adequate dental examination prior to surgery for a draining sinus of the neck.