An accurate diagnosis of odontogenic cutaneous sinus tract by different computed tomography unit setting

Abstract

Due to their rarity and the lack of associated dental symptoms, odontogenic cutaneous sinus tracts (OCSTs) are often misdiagnosed and confused with cutaneous lesions or non-odontogenic infections. It has been estimated that 50% of individuals affected by OCSTs are subjected to inappropriate treatments before the correct diagnosis is established. We describe the diagnosis and treatment of two cases of OCSTs. By using a computed tomography (CT) with soft tissue window setting, the extent of cortical bone destruction and the path of the sinus tract in the soft tissue was easily identified. Thus, we recommend the use of imaging techniques such as CT, which can confirm the odontogenic origin and the exact location of the OCST.

Keywords: Computed tomography; Cutaneous fistula; Periapical abscess.

Fig. 1

A. Clinical examination revealed a non-tender, erythematous nodule measuring approximately 0.7 cm in diameter on the left submandibular region. B. Preoperative panoramic view revealed a periapical rarefaction of the #31, #37, #47 teeth and impacted #38, #48 third molar teeth. C-E. Axial, coronal, and sagittal computed tomography showing the exact path of the odontogenic sinus tract marked with arrows.

Fig. 2

A. Extraoral view of a patient with an orocutaneous fistula in the right mandible cheek. B-D. Preoperative axial, coronal, and sagittal computed tomography (CT) reveal lingual bone destruction of the #45 tooth and mild swelling of the adjoining buccal soft tissue marked with arrows. E-G. Axial, coronal, and sagittal CT with the soft tissue setting demonstrate the origin and the route of the fistula connected to the subcutaneous layer of the skin marked with arrows.

Fig. 3

A. Postoperative clinical photo of nearly imperceptible scarring after ten months. B. Clinical view of the final prosthesis delivery. C. Panoramic radiogram showing a well-osseointegrated implant along with prosthetic delivery at the 7-month follow-up after implant installation.