Non-surgical endodontic management of an extraoral cutaneous sinus tract
Makaleler > Tam Makale · 2024
Yazarlar: Ilgın İLGENLİ, Esra Ismailoglu
International Dental Journal, Uluslararası, Wos, 2024, cilt 74, ss S318-S318
DOI: 10.1016/j.identj.2024.07.343
Özet
A cutaneous sinus-tract of odontogenic-origin is a rare condition where a pathway forms through the alveolar-bone, typically starting at the apex of an infected tooth and draining pus through the skin. As the condition progresses, its dental-origin often goes unrecognized, prompting patients to seek dermatological-treatment. A 16-year-old male-patient presented with a persistent-draining lesion on his face near the submandibular-region. Initially mistaking it for acne, the patient sought help only after experiencing spontaneous pain ten-days before his visit. Clinical-exams revealed sensitivity in #36 to percussion and palpation, with no response to electric-pulp-testing. Attempt to confirm the sinus tract's path with a gutta-percha was hindered by recent antibiotic-use. Radiographic-examination revealed deep dentin-caries and periapical-lucency, leading to a diagnosis of phoenix abscess with an extraoral sinus-tract. After placing a rubber-dam, the access cavity was prepared, and canal patencies established with #10 K-type hand-files. Canal preparations were done using a reciprocation-file-system (Scope, Turkey), with sodium-hypochlorite irrigation and ultrasonic-activation. Calcium-hydroxide was used as intracanal-medication in the 1st-session, followed by canal obturation two-weeks later. At the 6-month follow-up, the tooth was asymptomatic, extraoral-fistula had healed, and periapical-repair evident on radiograph. Managing a cutaneous draining sinus-tract of dental-origin primarily involves eliminating the source of infection. Accurate diagnosis and treatment typically lead to resolution over-time, while systemic antibiotics may only offer temporary relief, leading to superficial-healing. This case underscores the importance of considering dental causes in the differential diagnosis of orofacial skin-lesions. Collaboration between dentists and dermatologists is vital for managing such rare cases.