Single and Multiple Odontogenic Cutaneous Sinus Tracts

Abstract

Odontogenic cutaneous sinus tract (OCST) (synonyms: odontogenic cutaneous fistula, odontogenic subcutaneous granuloma, etc.) is an abnormal tube-shape formation which serves as a pathway for pus drainage from the locus of tooth–associated infection to the cutaneous lesion.

OCST is a collective term and commonly is manifested in six cutaneous forms: as dimpling with fistula, cutaneous infiltration, nodule, suppurated nodule, abscess, or even cyst-like cutaneous formation. The purpose of this paper is to present the diverse clinical and radiological appearance (cone-beam computed tomography [CBCT] and ultrasound [US]) of single and multiple OCSTs based on the literature and our four cases.

As long as limited publications present the ultrasound appearance of the OCSTs, we will focus on meticulous description of sonograms as well, giving a possibility for oral and maxillofacial surgeons to understand all advantages of that type of non-ionizing radiation diagnostics, avoiding misdiagnosis and mistreatment of OCSTs.

Case 1: A 24-year-old male with OCST to the left mandibular region from the lower left first molar. Cutaneous lesion of OCST manifested as a transition stage from cutaneous infiltration to abscess.

Case 2: A 41-year-old male with odontogenic cutaneous fistula of the right mandibular body region from the lower right second molar. It`s manifested as deep dimpling with active fistula.

Case 3: A 45-year-old male with unilateral multiple OCSTs: 1) odontogenic cutaneous fistula of the left cheek from the left second maxillary molar and 2) a scar from a surgically treated OCST located in the projection of the left mandible from the tooth #3.6.

Case 4: An 18-year-old male with OCST to left nasolabial fold and cheek from the upper left first molar. The pathology manifested as a subcutaneous abscess first and a nodule after the abscess lancing.

These cases highlight the diverse cutaneous manifestations of the OCSTs. The US appearances of different parts of the OCST are presented, the popular terminology for the same cutaneous lesions are discussed, the new terms are proposed, and the treatment strategies based on histologic results are debated.