Multiple foreign bodies causing an orocutaneous fistula of the cheek

Abstract

Foreign bodies impacted in the maxillofacial region are often a diagnostic challenge. They can be a source of chronic inflammatory reactions and infections leading to the formation of an orocutaneous fistula. Such orocutaneous fistulas cause significant morbidity in most patients, eventually requiring surgery. Recently, we encountered a very rare case of an orocutaneous fistula caused by multiple foreign bodies in the cheek. Precise removal of the foreign bodies was required, and a double-sided anterolateral thigh free flap was used to reconstruct the defect. Surgeons should be aware of the complications of multiple foreign bodies and should be able to diagnose these on careful clinical examination.

Keywords: Flap; Foreign body; Orocutaneous fistula.

Fig. 1.

A 75-year-old male patient presented with an orocutaneous fistula on the right cheek. (A) Profile view. (B) Oral view showing the internal opening of the orocutaneous fistula.

Fig. 2.

Preoperative radiographic findings showing impacted foreign bodies (red circled areas). (A) Plain radiography, lateral view. (B) Computed tomography, coronal view.

Fig. 3.

Retrieved foreign bodies during the operation: 22 linear metal needles (each needle was 4 mm in length).

Fig. 4.

Recurrent orocutaneous fistula with an even bigger opening at the same location.

Fig. 5.

Postoperative view with a double-sided anterolateral thigh free flap. (A) Immediate postoperative view. (B) Two-year postoperative view.