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Odontogenic cutaneous sinus tract associated with a mandibular second molar having a rare distolingual root: a case report.

Tian J, Liang G, Qi W, Jiang H - Head Face Med (2015)

Bottom Line: The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation.A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face.Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China. tianjun080511@126.com.

ABSTRACT

Introduction: Odontogenic cutaneous sinus tracts are often misdiagnosed as lesions of non-odontogenic origin, leading to the treatment of patients with unnecessary and ineffective therapies. Sinus tracts of endodontic origin usually respond well to endodontic therapy. However, root canal treatment of mandibular molars with aberrant canal anatomy can be diagnostically and technically challenging. Herein we present a patient with a cutaneous odontogenic sinus tract in the right submandibular area.

Case report: A 23-year-old Chinese female patient presented with a cutaneous odontogenic sinus tract that was initially misdiagnosed as a sebaceous cyst. The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation. With the aid of cone beam computed tomography (CBCT), it was confirmed that the causative factor of the cutaneous odontogenic sinus tract was chronic periapical periodontitis of the right mandibular second molar, which had a rare and curved distolingual root. The resolution of the sinus tract and apical healing was accomplished following nonsurgical root canal treatment.

Conclusion: A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face. Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy. This case report also indicates that CBCT imaging is useful for identifying the tooth involved, ascertaining the extent of surrounding bone destruction and accurately managing the aberrant canal morphology.

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Related in: MedlinePlus

Clinical and radiographic records during the treatment. (A) Plentiful errhysis originating from the pulp chamber during and after accessing the cavity. (B) 3% hydrogen peroxide along with bloody pus leaking from the extra-oral drainage sinus during irrigation. (C) Working length determination. (D) Floor of the pulp chamber showing four orifices after preparation. (E) The root canals were packed with Vitapex after preparation. (F) The resolution of the sinus tract after dressing for one month.
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Fig2: Clinical and radiographic records during the treatment. (A) Plentiful errhysis originating from the pulp chamber during and after accessing the cavity. (B) 3% hydrogen peroxide along with bloody pus leaking from the extra-oral drainage sinus during irrigation. (C) Working length determination. (D) Floor of the pulp chamber showing four orifices after preparation. (E) The root canals were packed with Vitapex after preparation. (F) The resolution of the sinus tract after dressing for one month.

Mentions: Under local anesthesia, a trapezoidal endodontic access opening was established, resulting in copious amounts of dark red blood exuding from the pulp chamber (Figure 2A). The four root canals, namely the mesiobuccal (MB), meisolingual (ML), distobuccal (DB) and distolingual (DL) canal, were located under a dental operating microscope (DOM) following clearance of the errhysis. Patency was achieved using an ISO size #8 or #6 stainless steel K-file (Mani, Japan). Irrigation of canals with 3% perhydrol using a 27-gauge needle resulted in bloody pus discharge from the extra-oral sinus (Figure 2B). The canals were then dressed with calcium hydroxide paste.Figure 2


Odontogenic cutaneous sinus tract associated with a mandibular second molar having a rare distolingual root: a case report.

Tian J, Liang G, Qi W, Jiang H - Head Face Med (2015)

Clinical and radiographic records during the treatment. (A) Plentiful errhysis originating from the pulp chamber during and after accessing the cavity. (B) 3% hydrogen peroxide along with bloody pus leaking from the extra-oral drainage sinus during irrigation. (C) Working length determination. (D) Floor of the pulp chamber showing four orifices after preparation. (E) The root canals were packed with Vitapex after preparation. (F) The resolution of the sinus tract after dressing for one month.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4414428&req=5

Fig2: Clinical and radiographic records during the treatment. (A) Plentiful errhysis originating from the pulp chamber during and after accessing the cavity. (B) 3% hydrogen peroxide along with bloody pus leaking from the extra-oral drainage sinus during irrigation. (C) Working length determination. (D) Floor of the pulp chamber showing four orifices after preparation. (E) The root canals were packed with Vitapex after preparation. (F) The resolution of the sinus tract after dressing for one month.
Mentions: Under local anesthesia, a trapezoidal endodontic access opening was established, resulting in copious amounts of dark red blood exuding from the pulp chamber (Figure 2A). The four root canals, namely the mesiobuccal (MB), meisolingual (ML), distobuccal (DB) and distolingual (DL) canal, were located under a dental operating microscope (DOM) following clearance of the errhysis. Patency was achieved using an ISO size #8 or #6 stainless steel K-file (Mani, Japan). Irrigation of canals with 3% perhydrol using a 27-gauge needle resulted in bloody pus discharge from the extra-oral sinus (Figure 2B). The canals were then dressed with calcium hydroxide paste.Figure 2

Bottom Line: The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation.A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face.Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China. tianjun080511@126.com.

ABSTRACT

Introduction: Odontogenic cutaneous sinus tracts are often misdiagnosed as lesions of non-odontogenic origin, leading to the treatment of patients with unnecessary and ineffective therapies. Sinus tracts of endodontic origin usually respond well to endodontic therapy. However, root canal treatment of mandibular molars with aberrant canal anatomy can be diagnostically and technically challenging. Herein we present a patient with a cutaneous odontogenic sinus tract in the right submandibular area.

Case report: A 23-year-old Chinese female patient presented with a cutaneous odontogenic sinus tract that was initially misdiagnosed as a sebaceous cyst. The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation. With the aid of cone beam computed tomography (CBCT), it was confirmed that the causative factor of the cutaneous odontogenic sinus tract was chronic periapical periodontitis of the right mandibular second molar, which had a rare and curved distolingual root. The resolution of the sinus tract and apical healing was accomplished following nonsurgical root canal treatment.

Conclusion: A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face. Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy. This case report also indicates that CBCT imaging is useful for identifying the tooth involved, ascertaining the extent of surrounding bone destruction and accurately managing the aberrant canal morphology.

Show MeSH
Related in: MedlinePlus