RESUMEN
BACKGROUND: Odontogenic cutaneous fistula (OCF) is a pathologic communication between the cutaneous surface of the face and oral cavity. Majority of oral cutaneous fistulas are reported to arise from chronic dental infection. Delay in treatment may result in chronic tissue injury as well as cosmetic deformities. Lesions are often misdiagnosed, leading to delayed management. Misdiagnosis may be the result of the variability of clinical morphological presentation and location of lesions compounded by the lack of knowledge that these lesions can have dental etiology. It is estimated that half of patients with OCF undergo multiple dermatologic surgical operations, antibiotic regimens, and other excisions and biopsies before a correct diagnosis is made. Herein, we present a systematic review to detail cases of odontogenic cutaneous lesions that had been previously misdiagnosed or managed inappropriately. In addition, we include a case report from our own institution. The aims are to demonstrate various presentations of OCF, increase awareness of plastic surgeons and oral maxillofacial surgeons to this pathological condition, and reinforce the importance of prompt diagnosis and treatment. METHODS: The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was conducted in PubMed, Web of Science, and Cochrane databases from January 1, 2013 to July 24, 2023. The following search terms were utilized: "odontogenic cutaneous fistula" OR "odontogenic cutaneous sinus." RESULTS: Twenty-three articles published between 2013 and 2023 were included in this review. In addition, we report a case from our own institution. A total of 28 cases were included in the review. CONCLUSIONS: Diagnosis of OCF is challenging for numerous reasons. Misdiagnosis can lead to multiple trials of antibiotics and surgical procedures as well as reoccurrence of the lesion. Cases summarized highlight the importance of communication between oral maxillofacial surgery, plastic surgery, other medical subspecialists, and dentists in the evaluation of patients with head and neck lesions. Physicians should consider dental etiology in the differential diagnosis of orofacial skin lesions, even if teeth appear normal on oral examination.
Asunto(s)
Fístula Cutánea , Adulto , Humanos , Masculino , Fístula Cutánea/diagnóstico , Fístula Cutánea/cirugía , Fístula Dental/diagnóstico , Diagnóstico Diferencial , Errores DiagnósticosRESUMEN
BACKGROUND: Odontogenic cutaneous sinus tracts are frequently misdiagnosed as cutaneous non-dental related pathologies, due to their lack of a typical morphology, their extraoral location, and the frequent absence of concomitant dental symptoms. An erroneous diagnosis may lead to long-lasting, invasive, and not resolutive surgical and medical treatments. METHODS: Four patients referred to our department lamenting the presence of a recurrent facial cutaneous sinus tract. They all had already had different wrong diagnoses and were treated with not resolutive therapies or surgeries. After a clinical and radiographical oral examination, the cutaneous fistulas were found to have a dental etiology, and the extraction of the compromised tooth was performed. RESULTS: One week after the tooth extraction, all the patients presented good healing of the intraoral mucosa. At the long-term follow-up in all four cases, the definitive closure of the extraoral sinus tract and a reduction of the scar was found. CONCLUSIONS: If a facial sinus tract is present, the odontogenic etiology should always be considered, since it can easily bring to the correct diagnosis, leading to a rapid resolution of the fistula. Once the dental origin has been confirmed, the suggested treatment for a conclusive resolution of the cutaneous sinus tract is the endodontic treatment or the extraction of the affected tooth.
Asunto(s)
Fístula Cutánea , Fístula Dental , Fístula Cutánea/diagnóstico , Fístula Dental/diagnóstico , Errores Diagnósticos/efectos adversos , Cara , Humanos , Extracción Dental/efectos adversosRESUMEN
OBJECTIVE: The objective of this study was to analyze difficult-to-diagnose cases of odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw (ARONJ) with facial subcutaneous abscesses by otolaryngologists. METHODS: The study was conducted in the department of otolaryngology of a university hospital. Seven patients exhibiting odontogenic infection and ARONJ with facial subcutaneous abscesses diagnosed at the department of otolaryngology in our hospital from January 2008 to December 2018 were included in the study. We investigated the following information obtained from the patients: clinical department for initial treatment, sex, age, offending tooth, causative disease, site of the fistula, symptoms, methods of diagnoses, and therapy. RESULTS: Odontogenic infection with facial subcutaneous abscess formation can occur in individuals in a wide range of age groups; however, the pathological manifestations of ARONJ are often observed in older women, frequently at the chin and accompanied by nodules and pain in the adjacent teeth. Computed tomography and orthopantomography are useful for diagnosis and are especially indicated for patients under long-term follow-up or with frequent recurrences. Magnetic resonance imaging, cytodiagnosis, and histological analysis might be necessary to exclude the possibility of tumors. Management of such facial subcutaneous abscesses comprises dental treatment and infection control, and f surgical removal of the abscess is usually not required. Treatments such as sequestrectomy and sitafloxacin administration are useful for patients with ARONJ. CONCLUSION: Our results demonstrated that for patients with facial subcutaneous abscesses, involvement of odontogenic infection and ARONJ should be considered.
Asunto(s)
Absceso/etiología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Fístula Dental/diagnóstico , Infección Focal Dental/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Osteonecrosis de los Maxilares Asociada a Difosfonatos/complicaciones , Niño , Fístula Dental/complicaciones , Femenino , Infección Focal Dental/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Radiografía Panorámica , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
An odontogenic cutaneous sinus tract (OCST) of dental origin is an uncommon and frequently misdiagnosed lesion that is caused by chronic periodontitis. Given that OCSTs often lack symptoms, are located on the lower face, and can have notable variations in clinical appearance, they can be mistaken for more common dermatologic diagnoses such as squamous cell carcinomas (SCCs) and cysts. We present 2 patients with OCSTs who were referred for cutaneous surgery for a rendered diagnosis of an SCC and epidermal cyst. A proper diagnosis was rendered after a high index of suspicion, and clinicopathologic correlation led to additional testing and eventual referral to oral surgery for an OCST.
Asunto(s)
Fístula Dental/diagnóstico , Fístula Dental/cirugía , Osteítis/complicaciones , Osteítis/cirugía , Senos Paranasales/cirugía , Carcinoma de Células Escamosas/diagnóstico , Fístula Dental/etiología , Diagnóstico Diferencial , Quiste Epidérmico/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteítis/diagnóstico , Senos Paranasales/patología , Resultado del TratamientoRESUMEN
A cutaneous sinus tract of dental origin is relatively uncommon and may easily be misdiagnosed because of its unusual occurrence and absence of dental symptoms. Extraoral drainage depends on the location of the affected tooth as well as on specific factors such as the virulence of the microorganism, resistance of the patient's body, and the relationship between anatomy and muscle facial attachments.
Asunto(s)
Fístula Cutánea/diagnóstico , Fístula Dental/diagnóstico , Drenaje/métodos , Adolescente , Fístula Cutánea/cirugía , Fístula Dental/cirugía , Estética , Femenino , HumanosAsunto(s)
Infecciones por Acinetobacter/diagnóstico , Acinetobacter/aislamiento & purificación , Ritidoplastia/efectos adversos , Úlcera Cutánea/diagnóstico , Infecciones por Acinetobacter/microbiología , Actinomicosis/diagnóstico , Fístula Dental/diagnóstico , Diagnóstico Diferencial , Cara , Femenino , Humanos , Persona de Mediana Edad , Ritidoplastia/métodos , Úlcera Cutánea/microbiología , Esporotricosis/diagnósticoRESUMEN
A 48-year-old Chinese woman was referred to our center with a 7-month history of a painful lesion on her left jaw that had been gradually increasing in size. The patient noted occasional purulent and bloody discharge from the lesion. She denied having a toothache. An examination revealed an erythematous nodule with perilesional puckering superior to the left body of the mandible, measuring 7 × 8 mm, with no discharge or surrounding inflammation. There was no cervical lymphadenopathy. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
Asunto(s)
Fístula Dental/diagnóstico , Dolor Facial/etiología , Caries Dental/complicaciones , Fístula Dental/etiología , Femenino , Humanos , Persona de Mediana Edad , Absceso Periapical/complicaciones , Supuración/complicacionesAsunto(s)
Fístula Cutánea/patología , Fístula Dental/diagnóstico , Dermoscopía/métodos , Surco Nasolabial/patología , Enfermedades de la Piel/patología , Anciano , Biopsia con Aguja , Fístula Cutánea/diagnóstico , Fístula Cutánea/cirugía , Fístula Dental/patología , Humanos , Inmunohistoquímica , Masculino , Surco Nasolabial/cirugía , Pronóstico , Enfermedades Raras , Enfermedades de la Piel/diagnóstico , Resultado del TratamientoRESUMEN
Les fistules cutanées des dents et des maxillaires sont une des complications majeures de l'infection. La localisation dépend d'éléments anatomiques comme le rapport relatif des lésions avec les tables osseuses, le tissu cellulaire et les plans musculoaponévrotiques. Les étiologies correspondantes sont nombreuses avec dans un ordre croissant d'importance les dents nécrosées ou un échec de traitement canalaire, les parodontolyses, les inclusions et les nécroses osseuses. Le diagnostic différentiel est conséquent, les erreurs sont courantes! Elles se soldent par des échecs de traitement qui peuvent être délétères pour les tissus. D'où l'intérêt de bien conduire l'examen clinique afin de poser un diagnostic précis permettant de réaliser un traitement étiologique approprié et rapide
Asunto(s)
Fístula Dental/diagnóstico , Fístula Dental/etiología , Maxilar , Marruecos , Tumores Odontogénicos , DienteRESUMEN
La fistula cutánea odontogénica (FCO) es el resultado de una canalización anormal originada a partir de una infección crónica periapical. Representa todo un reto diagnóstico ya que frecuentemente son lesiones etiquetadas erróneamente como dermatológicas. El diagnóstico diferencial es amplio, incluyendo el granuloma piogénico, tuberculosis cutánea o malformaciones congénitas entre otros. Exponemos el caso de un varón de 46 años diagnosticado de FCO que presentó una rápida mejoría tras exodoncia de las piezas dentales afectas y fistulectomía. Consideramos importante el conocimiento de esta patología para evitar retrasos innecesarios en el diagnóstico y tratamiento adecuado (AU)
Odontogenic cutaneous fistula (OCF) is the result of an abnormal canalization originating from chronic periapical infection. It represents a diagnostic challenge, as it is frequently misdiagnosed as dermatological lesion. There is a broad differential diagnosis, including pyogenic granuloma, cutaneous tuberculosis or congenital malformations, among others. We report the case of a 46-year-old man diagnosed with OCF who presented a rapid improvement after extraction of the affected dental pieces and fistulectomy. We consider knowledge of this pathology to be important in order to avoid unnecessary delays in diagnosis and proper treatment (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fístula Dental/diagnóstico , Fístula Cutánea/diagnóstico , Extracción Dental , Diagnóstico Diferencial , Radiografía Panorámica , Absceso Periapical/complicaciones , Necrosis de la Pulpa Dental/complicacionesRESUMEN
ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.
RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Osteomielitis/diagnóstico , Enfermedades Mandibulares/diagnóstico , Osteomielitis/cirugía , Osteomielitis/tratamiento farmacológico , Osteonecrosis/diagnóstico , Absceso Periapical/diagnóstico , Supuración , Radiografía Panorámica , Enfermedades Mandibulares/cirugía , Enfermedades Mandibulares/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Enfermedad Crónica , Fístula Dental/diagnóstico , Desbridamiento , Estudios Controlados Antes y Después , Antibacterianos/uso terapéuticoRESUMEN
La existencia de una íntima conexión entre el conducto radicular y el ligamento periodontal, ha dado lugar a lo que se conoce como relaciones endoperiodontales. Esto se debe a la presencia de varias vías anatómicas de comunicación entre ambas entidades: el foramen apical, los forámenes laterales pertenecientes a conductos accesorios y conductillos dentinarios en zonas de ausencia del cemento dentario protector. Los microorganismos y sus agentes tóxicos tienen la capacidad de afectar ambos tejidos en esa interrelación física y biológica. El diagnóstico diferencial entre enfermedad endodóntica y periodontal es de vital importancia para la elección del tratamiento y el pronóstico a distancia.
The intimate connection between the root canal and theperiodontal ligament generates a concept that is known asendo-periodontal relationships. This is due to the presence ofseveral anatomical communications between them: apical foramen,lateral foramina and dentinal tubules denuded of theircementum coverage. Microorganisms and their toxic agentscan affect both tissues due to this physical and biological interrelation.Proper differential between endodontic and periodontaletiology is vital to the accurate choice of treatment andfor the long term prognosis.
Asunto(s)
Humanos , Cavidad Pulpar/anatomía & histología , Enfermedades de la Pulpa Dental/fisiopatología , Enfermedades Periodontales/fisiopatología , Ligamento Periodontal/anatomía & histología , Diagnóstico Diferencial , Fístula Dental/complicaciones , Fístula Dental/diagnóstico , Cavidad Pulpar/microbiología , Necrosis de la Pulpa Dental/microbiología , Enfermedades Periodontales/microbiología , Bolsa Periodontal/microbiología , Retratamiento/métodos , Tratamiento del Conducto Radicular/métodosRESUMEN
Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.
Asunto(s)
Variación Anatómica , Enfermedades Óseas Infecciosas/etiología , Enfermedades Óseas Infecciosas/patología , Enfermedades Óseas Infecciosas/terapia , Periodontitis Crónica/complicaciones , Periodontitis Crónica/etiología , Fístula Cutánea/diagnóstico , Fístula Cutánea/etiología , Fístula Cutánea/patología , Fístula Cutánea/terapia , Fístula Dental/diagnóstico , Fístula Dental/etiología , Fístula Dental/patología , Fístula Dental/terapia , Errores Médicos/efectos adversos , Absceso Periapical/complicaciones , Absceso Periapical/etiología , Tratamiento del Conducto Radicular/efectos adversos , Tratamiento del Conducto Radicular/métodos , Raíz del Diente/anatomía & histología , Proceso Alveolar/patología , Enfermedades Óseas Infecciosas/diagnóstico , Diagnóstico Diferencial , Gutapercha/uso terapéutico , Humanos , Enfermedad Iatrogénica , Masculino , Diente Molar/diagnóstico por imagen , Diente Molar/patología , Radiografía Dental , Retratamiento , Irrigantes del Conducto Radicular/uso terapéutico , Tratamiento del Conducto Radicular/instrumentación , Hipoclorito de Sodio/uso terapéutico , Raíz del Diente/diagnóstico por imagen , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
Pilonidal sinus is a chronic inflammatory condition associated with penetration of hair particles into the skin. It is rare in the chin area and, to our knowledge, there is only one such reported case. A 56-year-old man was previously admitted to a private clinic, with a hard mass on his anterior buccal sulcus. Three of the patient's teeth were extracted as the swelling was thought to be associated with a dental infection. Because the fistula did not resolve, the patient was referred to our department. Following radiological and clinical examinations, the hard mass was reached intraorally and hair shafts were seen inside it. The area was closed primarily after cleaning the inflammatory tissues and the hairs. The recovery period was uneventful. In this case report, we present a pilonidal sinus encountered in the chin area, the wrong treatment initially given to the patient and the subsequent treatment carried out by us.
Asunto(s)
Errores Diagnósticos , Seno Pilonidal/diagnóstico , Mentón , Fístula Dental/diagnóstico , Fístula Dental/cirugía , Humanos , Masculino , Persona de Mediana Edad , Seno Pilonidal/cirugía , Piel/patologíaRESUMEN
Pyogenic cutaneous lesions of the cervicofacial region may have a variety of causes but one possibility that should be considered is a cutaneous sinus tract (CST) of dental origin. Correct diagnosis is based on a high index of suspicion and radiologic evidence of a dental pathology. Patients with odontogenic CST should be referred to a dentist and the treatment consists of either endodontic therapy or extraction of the involved tooth. We present a case report with misdiagnosis of CST of dental origin.
Asunto(s)
Fístula Cutánea/diagnóstico , Fístula Dental/diagnóstico , Fístula Cutánea/diagnóstico por imagen , Fístula Cutánea/patología , Fístula Cutánea/cirugía , Fístula Dental/diagnóstico por imagen , Fístula Dental/patología , Fístula Dental/cirugía , Infección Focal Dental/diagnóstico , Infección Focal Dental/diagnóstico por imagen , Infección Focal Dental/cirugía , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Tratamiento del Conducto RadicularRESUMEN
BACKGROUND: 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. Most cases respond to conservative, nonsurgical root canal therapy. Our objective is to report 2 cases of cutaneous sinus tract secondary to chronic periapical dental infection that were recently observed at our hospital. METHODS: We present 2 cases of recurrent suppurative facial lesions that were initially misdiagnosed and treated with oral antibiotics without response. RESULTS: Clinical findings included palpable facial nodules with drainage, palpable intraoral cords, and poor dentition with gingivitis; radiologic examination showed a periapical disease process consistent with dental sinus tracts. Both of the cases were referred to the maxillofacial department, where the cyst and nonrestorable teeth were extracted. CONCLUSION: Because patients with cutaneous facial sinus tracts of dental origin often do not have obvious dental symptoms, a possible dental etiology may be overlooked. If dental origin is suspected, the diagnosis is easily confirmed by dental examination and dental roentgenograms of the involved area. Early correct diagnosis, based on radiologic evidence of a periapical root infection and treatment of these lesions can help prevent unnecessary and ineffective antibiotic therapy or surgical treatment, reducing the possibility of further complications such as sepsis and osteomyelitis.
Asunto(s)
Fístula Cutánea/diagnóstico , Fístula Dental/diagnóstico , Fístula Cutánea/terapia , Fístula Dental/terapia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
No disponible
Asunto(s)
Masculino , Humanos , Fístula Dental/complicaciones , Fístula Dental/diagnóstico , Fístula Dental , Ultrasonografía/tendencias , UltrasonografíaRESUMEN
Persistent apical periodontitis related to a nonvital tooth that does not resolve following root canal treatment may be compatible with health and may not require further intervention. This research aimed to develop a Deterioration Risk Score (DRS) to differentiate lesions requiring further intervention from lesions likely to be compatible with health. In this cross-sectional study, patient records (2003-2008) were screened for root-filled teeth with periapical radiolucency visible on periapical radiographs taken at treatment and at recruitment at least 4 yr later. The final sample consisted of 228 lesions in 182 patients. Potential demographic and treatment risk factors were screened against 3 categorical outcomes (improved/unchanged/deteriorated), and a multivariate independent multinomial probit regression model was built. A 5-level DRS was constructed by summing values of adjusted regression coefficients in the model, based on predicted probabilities of deterioration. Most lesions (127, 55.7%) had improved over time, while 32 (14.0%) remained unchanged, and 69 (30.3%) had deteriorated. Significant predictors of deterioration were as follows: time since treatment (relative risk [RR]: 1.11, 95% confidence interval [CI]: 1.01-1.22, p = .030, rounded beta value = 1, for every year increase after 4 yr), current pain (RR: 3.79, 95% CI: 1.48-9.70, p = .005, rounded beta value = 13), sinus tract present (RR: 4.13, 95% CI: 1.11-15.29, p = .034, rounded beta value = 14), and lesion size (RR: 7.20, 95% CI: 3.70-14.02, p < .001, rounded beta value = 20). Persistent apical periodontitis with DRS <15 represented very low risk; 15-20, low risk; 21-30, moderate risk; 31-40, high risk; and >40, very high risk. DRS could help the clinician identify persistent apical periodontitis at low risk for deterioration, and it would not require intervention. When validated, this tool could reduce the risk of overtreatment and contribute toward targeted care and better efficiency in the timely management of disease.
Asunto(s)
Algoritmos , Periodontitis Periapical/terapia , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Árboles de Decisión , Fístula Dental/diagnóstico , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Predicción , Humanos , Masculino , Persona de Mediana Edad , Probabilidad , Radiografía de Mordida Lateral , Medición de Riesgo , Factores de Riesgo , Tratamiento del Conducto Radicular/métodos , Diente no Vital/terapia , Odontalgia/diagnóstico , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Root duplication, or multiple roots, is a very rare anatomy of the maxillary central incisor. METHODS: This case report describes a permanent central incisor having 2 distinct roots as an assumed sequela of the avulsion and replantation of a primary incisor. RESULTS: The permanent successor might have had a disturbance of development because of the traumatic injury and discontinuity in the treatment after replantation. Conventional endodontic treatment followed by esthetic restoration was performed on the tooth. CONCLUSIONS: Clinicians should consider the potential prognoses and complications of traumatic injuries to primary teeth.
Asunto(s)
Incisivo/anomalías , Raíz del Diente/anomalías , Adolescente , Fístula Dental/diagnóstico , Necrosis de la Pulpa Dental/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Incisivo/lesiones , Absceso Periapical/diagnóstico , Obturación del Conducto Radicular/métodos , Preparación del Conducto Radicular/métodos , Tratamiento del Conducto Radicular/métodos , Avulsión de Diente/complicaciones , Avulsión de Diente/cirugía , Reimplante Dental/métodos , Diente Primario/lesionesRESUMEN
Facial and cervical area sinus tracts can be odontogenic or non-odontogenic, and so clinicians should be aware that lesions with a dental origin can be confused with dermatological lesions. We describe three cases of cutaneous lesions of dental origin that were initially misdiagnosed as being dermatological in origin. Multiple unsuccessful treatments were attempted but the lesions failed to heal. However, conservative endodontic intervention resulted in complete resolution of the causative periapical lesions within a short period, making surgery unnecessary. Dental aetiology, as part of a differential diagnosis, must be considered in such oro-facial lesions.