Four atypical cases of misdiagnosed facial cutaneous sinuses of dental origin.

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.

Odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw with facial subcutaneous abscess formation: A retrospective clinical study of difficult-to-diagnose cases.

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.

Tratamiento regenerativo de lesión interproximal consecuente a fractura del tercio medio en diente permanente joven / Regenerative treatment of interproximal lesion following middle third fracture in a young permanent tooth

Se presenta un caso clínico de fractura radicular del tercio medio, de pieza 2.1 con desplazamiento de los cabos de fractura. Es tratado con un novedoso procedimiento terapéutico, mediante la utilización de un biomaterial de tercera generación osteoconductor, osteogénico y osteoinductor. Se obtiene la reparación del tejido conectivo interproximal y la formación de tejido calcificado (AU)

We present a clinical case of root fracture of the middle third, piece 2.1 with displacement of the fracture ends. It is treated with a novel therapeutic procedure, using a thirdgeneration osteoconductive, osteogenic and osteoinductive biomaterial. Interproximal connective tissue repair and calcified tissue formation are obtained (AU)

Closure of Oronasal Fistulae Post Palatoraphy with Tongue Flap in Bilateral Complete Cleft Lip Palate Patient: A Case Report

ABSTRACT@#Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy. Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported. Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful, and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.

Cutaneous odontogenic sinus: an inflammatory mimicker of squamous cell carcinoma and epidermal cysts.

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.

Esthetic improvement of a cutaneous sinus tract of odontogenic origin.

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.

Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata.

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 sinus tract can be conservatively healed with endodontic treatment alone.

Painful jaw lesion.

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?

Fistules cutanées d'origine dentaire

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

Fístula cutánea odontogénica: un reto diagnóstico / Odontogenic cutaneous fistula: a diagnostic challenge

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)

A Case of External Dental Fistula Related to a Fixed Cantilever Bridge.

An external dental fistula is a skin manifestation caused by an underlying dental problem. We report a rare case of external dental fistula associated with a fixed cantilever denture. A 77-year-old Japanese woman presented with an enlarging reddish granulomatous lesion on her right cheek that was diagnosed as an external dental fistula. A fixed cantilever denture had initially been attached to her upper jaw with her seven bona fide teeth. However, six teeth were completely lost and the denture was attached to only one tooth, which showed apical periodontitis. Subsequently, the external dental fistula developed. We should keep in mind that a patient with a fixed cantilever denture can suffer from apical periodontitis and a subsequent external dental fistula due to a failure to maintain appropriate oral hygiene.

Chronic Suppurative Osteomyelitis of the Mandible Treated with Antibiotics Complemented with Surgical Treatment: A Case Report / Osteomielitis Crónica Supurativa en Mandíbula Tratada con Antibióticos y Cirugía: Reporte de Caso

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.

Relaciones endoperiodontales: una frontera transitable / Endoperiodontal relationships: a passable border

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.

Odontogenic cutaneous sinus tract presenting as a growing cheek mass in the emergency department.

An odontogenic cutaneous sinus tract (OCST) is a rare extraoral sinus tract related to a chronic draining dental infection, typically apical periodontitis. OCST usually presents as an erythematous and non-tender nodule and often requires endodontic treatment for resolution of the sinus tract. If there is disruption of the mandibular cortex, it may be difficult to differentiate an OCST from a non-odontogenic malignant mass in patients without dental symptoms. This report describes a rare case of OCST presenting as a left cheek mass in a 21-year-old man which was initially diagnosed in the emergency department.