Extraoral Cutaneous Sinus Research Articles

Non-surgical endodontic management of an extraoral cutaneous sinus tract

Non-surgical endodontic management of an extraoral cutaneous sinus tract

Combined non-surgical and surgical management of misdiagnosed cutaneous sinus tract of endodontic origin – 15 months CBCT follow-up

Introduction and aim. An extraoral cutaneous sinus tract of endodontic origin represents a skin condition that appears due to an infection that could be primary or secondary to trauma accompanied by alveolar bony changes. It may be easily misdiagnosed and inappropriately treated due to lack of inadequate expertise on part of medical professionals followed by faulty treatment which can complicate the case further. Description of case. This case report intends to highlight a case of a sixteen-year-old male patient referred for an extraoral cutaneous sinus tract misdiagnosed and insufficiently treated by a general physician followed by general dentists for more than a month due to lack of proficiency in the field of endodontics. The clinical and radiographic examinations confirmed the pulpal origin due to trauma related to permanent mandibular incisors. A combination of non-surgical root canal therapy followed by periapical surgery was performed leading to a significant healing of the lesion. Conclusion. Accurate diagnosis is the key to treat draining sinus tracts of endodontic origin. Root canal treatment and endodontic surgery should be used judiciously for effectively eliminating the pathogens thus providing healing and repair mechanisms a chance to achieve the desired result.

Endodontic management of unusual extraoral cutaneous sinus tract

Chronically, draining cutaneous sinus tracts are a common manifestation of pulpal necrosis with periapical pathosis that requires endodontic treatment to heal. However, it is frequently misdiagnosed with cutaneous lesions and incorrectly treated. A clinical case of an 8-year-old girl presented with an extraoral cutaneous sinus tract of the right submandibular region after long-term pus drainage was misdiagnosed by her dermatologist. The odontogenic origin of the sinus tract was made by tracing an unusual pathway of the sinus tract utilizing cone-beam computed tomography. The clinical and radiographic examination revealed a necrotic pulp, with chronic periapical abscess and cutaneous drainage of the immature mandibular right first molar. Endodontic therapy and mineral trioxide aggregate apexification were performed. The cutaneous sinus tract showed signs of healing after 1 month from treatment initiation and complete radiographic healing was noted after 18th month recall. Cutaneous extraoral sinus tracts of endodontic origin can be easily misdiagnosed and mistreated. Utilizing cone-beam computed tomography to trace the sinus tract revealed an unusual pathway confirming the odontogenic origin of the sinus tract. Correct treatment resulted in regaining the patient her self-confidence, saving the tooth, and healing of the facial sinus tract.

A clinical predicament- Extraoral cutaneous sinus tract of dental origin

Extra oral cutaneous sinus tracts are generally misdiagnosed because of absence of dental symptoms. In this case report we have treated a 12-year-old patient, initially misdiagnosed and treated as a skin lesion by the physician. Once the accurate diagnosis of dental origin was made, definitive treatment through conventional root canal therapy reduced the incidence of complications. He had a painless erythematous nodule present for the past 3months extra orally. It was soft on palpation and elicited a purulent discharge. Intra oral examination revealed carious lesion in mesio-occlusal aspect of left mandibular first molar. Radiographic examination revealed pulp involvement and periapical radiolucency. He was diagnosed with a non-vital mandibular molar with chronic apical periodontitis and a draining extra oral sinus. Endodontic intervention was performed with intracanal medicament placed for two weeks. During final visit, root canals were obturated. There was resolution of sinus tract with minimal scar after 7months. 15 months follow up showed scar completely resolved extra orally. Several case reports reveal that if appropriate diagnosis could not be made, incorrect treatment causes cutaneous sinus tract to reoccur. This scientific paper aims to present a dental literature review of cutaneous sinus tracts having dental origin and to report a case treated successfully by non-surgical conservative endodontic therapy. Extra oral cutaneous sinus tracts are rare entity, hard to diagnose unless the treating clinician considers the possibility of its dental origin. Proper management curbs the disease progression and protects patient from emotional upheaval.

Non-surgical endodontic retreatment of extra-oral cutaneous sinus using propolis as an intracanal medicament: A case report

This case report describes a successful non-surgical endodontic retreatment of the lower right central incisor with periapical lesion with tender extra-oral cutaneous sinus at the mental region. The extra-oral cutaneous sinus was misdiagnosed as acne & was treated by a skin specialist. The tooth underwent root canal treatment in which Indian Propolis was used as an intracanal medicament. The tooth was obturated after 7 months after initiation of therapy. At 12 months recall intraoral periapical radiograph showed healing of the periapical lesion & the extra-oral cutaneous sinus was healed with scarring. A thorough clinical evaluation, proper diagnosis and multidisciplinary treatment protocol are important for the success of the treatment. This paper suggest that Indian Propolis was effective in the healing of periapical lesion with extra oral sinus. Keywords: Extra-oral sinus, Indian Propolis, Intracanal medicament & Periapical lesion

Extraoral cutaneous sinus tracts of dental origin: A report of two pedodontic cases

Extraoral cutaneous sinus tracts of dental origin: A report of two pedodontic cases

Treatment of an extraoral cutaneous sinus tract with endodontic intervention: a case report

Dental abscess is the accumulation of exudate in the alveolar bone surrounding the root as a result of infection originating from the pulp.[1] Bacteria, trauma and irritation are among the causative factors. However, the most common etiological factors are bacteria residing in the necrotic pulp tissue. If the infected pulp tissue is untreated, toxic products can spread through the apical foramen into the peri-radicular tissues. The toxic products introduced into periapical tissues may affect the periodontal membrane and the periapical alveolar bone.[1] The immune system acts in response to the intra-canal microorganisms, necrotic tissues and metabolites originating from pulpal degradation. Moreover, the microbiologically induced inflammation may penetrate the alveolar bone and spread along the path of least resistance. As a result, the inflammatory event can reach and diffuse the surrounding soft tissue and create a path for drainage.[2,3] Drainage is affected by the tooth, virulence of the microorganisms and the relation of the tooth with facial muscle attachments. [2,4] Furthermore, the fistulation and drainage with extraoral chronic apical abscess reduces the patient’s quality of daily life and has a negative impact on esthetic appearance. The following report describes a case of extra-oral fistulation associated with non-vital mandibular first molar teeth and the successful result obtained following endodontic treatment.

English

Cutaneous sinus tracts of dental origin are often initially misdiagnosed and inappropriately treated because of their uncommon occurrence and the absence of symptoms in approximately half the individuals affected. This paper reports a case describing the diagnosis and treatment of an extra-oral cutaneous sinus tract of odontogenic origin in relation to a mandibular left first molar. Non-surgical endodontic treatment was performed, and it resulted in resolution of the sinus tract and promoted peri-apical healing of the tooth involved. Key words: Apical periodontitis, cutaneous sinus tract, necrosis pulp, non-surgical endodontic treatment.

Non-surgical endodontic treatment of extraoral sinus with triple antibiotic paste and mineral trioxide aggregate obturation

Several non-odontogenic disorders may also cause a cutaneous extraoral sinus tract. The diagnosis is not always easy unless the treating clinician considers the odontogenic origin. The present case report discusses diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin in relation to a mandibular left permanent first molar with open apex (diagnosed as suppurative periradicular periodontitis with an extraoral cutaneous sinus tract opening in the mandibular posterior region). Carious pulp exposure was also noticed in primary second molar. Non-surgical endodontic therapy was performed using triple antibiotic paste as intracanal medicament. Patient responded well and the cutaneous lesions healed uneventfully. In the absence of any clinical symptom complete obturation was done with the help of mineral trioxide aggregate in mandibular left first permanent molar and pulpectomy was performed in primary second molar. Patient was kept on regular follow-up.

Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin using Nd:YAG laser: An endodontic challenge

The extraoral cutaneous sinus tract of dental origin is an uncommon, but well-documented condition. However, several non-odontogenic disorders may also cause an extraoral sinus tract. The diagnosis is not always easy unless the treating clinician considers the odontogenic origin. The present case report discusses diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin in relation to a mandibular left cannine (diagnosed as asymptomatic suppurative periradicular abscess with an extraoral cutaneous sinus tract opening in the mandibular mental region). Non-surgical endodontic therapy was performed using Nd:YAG laser. To present a case report describing the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin in relation to a mandibular left cannine. The patient responded well, and the cutaneous lesions healed uneventfully.

Extraoral Sinus Tract Misdiagnosed as an Endodontic Lesion

The extraoral sinus tract may occur as a result of an inflammatory process associated with a necrotic pulp. However, several non-odontogenic disorders may also produce an extraoral sinus tract. Thus, the differential diagnosis of this clinical finding is of paramount importance in providing appropriate clinical care because misdiagnosis of this condition may result in healing failure or unnecessary treatment. This case report of a 19-yr-old male patient describes an extraoral cutaneous sinus tract misdiagnosed as an endodontic lesion. Consequently, the patient underwent unnecessary exploratory procedures and antibiotic therapy. Identification of the inflammatory source of the lesion and removal of the affected tissue led to tissue healing.