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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

Postoperative radiographs of endodontic treatment and follow-up after five and nine months. (A) Post treatment periapical radiograph revealing that the obturation is of good quality. At the five-month follow-up, the extra-oral view (B) shows that the sinus tract had disappeared but left a scar in the right mandibular region. The periapical radiograph (C) shows the healing of periapical tissues. After nine months, postoperative CBCT images of the sagittal (D and E), coronal (F and G) and axial view (H-J)view confirmed the apical healing and adequate obturation. DB, distobuccal; MB, meisobuccal; DL, distolingual; ML, meisolingual.
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Fig3: Postoperative radiographs of endodontic treatment and follow-up after five and nine months. (A) Post treatment periapical radiograph revealing that the obturation is of good quality. At the five-month follow-up, the extra-oral view (B) shows that the sinus tract had disappeared but left a scar in the right mandibular region. The periapical radiograph (C) shows the healing of periapical tissues. After nine months, postoperative CBCT images of the sagittal (D and E), coronal (F and G) and axial view (H-J)view confirmed the apical healing and adequate obturation. DB, distobuccal; MB, meisobuccal; DL, distolingual; ML, meisolingual.

Mentions: At the next visit, about one month later, the extra-oral sinus tract had healed and no purulent discharge was noted (Figure 2F). The canals were obturated using the continuous wave obturation technique with warm gutta-percha (Sybron Endo, Orange, CA) and AH Plus sealer (Dentsply, Maillefer, USA). The postoperative radiograph revealed a successful obturation (Figure 3A). At the five-month follow-up period, the sinus tract had disappeared but a scar from the surgery was left on the right submandibular area (Figure 3B). A radiograph confirmed adequate obturation and resolution of the periapical tissues (Figure 3C). Postoperative CBCT images after nine months confirmed the apical healing and adequate obturation (Figure 3D-J). The patient was subsequently advised to receive an appropriate coronal restoration.Figure 3


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)

Postoperative radiographs of endodontic treatment and follow-up after five and nine months. (A) Post treatment periapical radiograph revealing that the obturation is of good quality. At the five-month follow-up, the extra-oral view (B) shows that the sinus tract had disappeared but left a scar in the right mandibular region. The periapical radiograph (C) shows the healing of periapical tissues. After nine months, postoperative CBCT images of the sagittal (D and E), coronal (F and G) and axial view (H-J)view confirmed the apical healing and adequate obturation. DB, distobuccal; MB, meisobuccal; DL, distolingual; ML, meisolingual.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Postoperative radiographs of endodontic treatment and follow-up after five and nine months. (A) Post treatment periapical radiograph revealing that the obturation is of good quality. At the five-month follow-up, the extra-oral view (B) shows that the sinus tract had disappeared but left a scar in the right mandibular region. The periapical radiograph (C) shows the healing of periapical tissues. After nine months, postoperative CBCT images of the sagittal (D and E), coronal (F and G) and axial view (H-J)view confirmed the apical healing and adequate obturation. DB, distobuccal; MB, meisobuccal; DL, distolingual; ML, meisolingual.
Mentions: At the next visit, about one month later, the extra-oral sinus tract had healed and no purulent discharge was noted (Figure 2F). The canals were obturated using the continuous wave obturation technique with warm gutta-percha (Sybron Endo, Orange, CA) and AH Plus sealer (Dentsply, Maillefer, USA). The postoperative radiograph revealed a successful obturation (Figure 3A). At the five-month follow-up period, the sinus tract had disappeared but a scar from the surgery was left on the right submandibular area (Figure 3B). A radiograph confirmed adequate obturation and resolution of the periapical tissues (Figure 3C). Postoperative CBCT images after nine months confirmed the apical healing and adequate obturation (Figure 3D-J). The patient was subsequently advised to receive an appropriate coronal restoration.Figure 3

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