Extraoral draining sinus of odontogenic origin usually lacks intraoral symptoms, thus it may be diagnosed as a cutaneous lesion. It is rare and may be confused with a wide variety of diseases for example furuncle, pericoronitis in relation to the mandibular third molars, parotid fistula, preauricular sinuses, periapical and periodontal pathology, and many more. Patients might seek treatment from their physician as they are not aware of its odontogenic origin and these cases usually are misdiagnosed and leading to inappropriate treatment.
Objective: To discuss the detailed management of two cases of extraoral draining sinus that were successfully treated.
Case Reports: The first case was referred by the Department of Oral and Maxillofacial Surgery, for management of extraoral draining sinus originating from tooth 36. In the second case, the extraoral draining sinus is caused by pulpal necrosis of several mandibular anterior teeth. Intra-radicular microorganisms in infected root canals primarily obligate anaerobes have been the aetiologic cause of apical periodontitis if left untreated may cause these types of symptoms.
Conclusion: As it is uncommon and the absence of any dental symptoms, thus, it’s paramount important to diagnose these types of cases to treat the disease and to avoid unnecessary treatments such as prolonged prescription of antibiotics. Therefore, the dental cause should be ruled out for any cutaneous sinus tract so that a correct diagnosis can be ascertained, and proper management can be delivered to the patient.
- ammut S, Malden N, Lopes V. Facial cutaneous sinuses of dental origin - A diagnostic challenge. Br Dent J. 2013; 215(11):555-8.
- Tekwani RA, Nanda Z, Rudagi K, Reddy KK, Deore R, Fotani S. Nonsurgical management of an extraoral sinus tract of endodontic origin: A case report. J Oper Dent Endod. 2019; 4(1):54-6.
- Bai J, Ji AP, Huang MW. Submental cutaneous sinus tract of mandibular second molar origin. Int Endod J. 2014; 47(12):1185-91.
- Varghese LL, Bhattacharya A, Sharma P, Apratim A. Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin. BMJ Case Rep. 2020; 13(7):e234699.
- Gupta M, Das D, Kapur R, Sibal N. A clinical predicament--diagnosis and differential diagnosis of cutaneous facial sinus tracts of dental origin: A series of case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(6):e132-6.
- Andrade-Junior CV, de Souza KH, Gomes AC, da Silva EJNL. Odontogenic cutaneous sinus tract: Case report. Dental Press Endod. 2013; 3(2):70-4.
- Swales KL, Rudralingam M, Gandhi S. Extraoral cutaneous sinus tracts of dental origin in the paediatric patient. A report of three cases and a review of the literature. Int J Paediatr Dent. 2016; 26(5):391-400.
- Sotiropoulos GG, Farmakis ET. Diagnosis and conservative treatment of extraoral submental sinus tract of endodontic origin: A case report. J Clin Diagn Res. 2014; 8(10):ZD10-1.
- Hülsmann M, Heckendorff M, Lennon A. Chelating agents in root canal treatment: Mode of action and indications for their use. Int Endod J. 2003; 36(12):810-30.
- Niu LN, Luo XJ, Li GH, Bortoluzzi EA, Mao J, Chen JH, Gutmann JL, Pashley DH, Tay FR. Effects of different sonic activation protocols on debridement efficacy in teeth with single-rooted canals. J Dent. 2014; 42(8):1001-9.
- Johnson BR, Remeikis NA, Van Cura JE. Diagnosis and treatment of cutaneous facial sinus tracts of dental origin. J Am Dent Assoc. 1999; 130(6):832-6.
- Kishore Kumar RV, Devireddy SK, Gali RS, Chaithanyaa N, Chakravarthy C, Kumarvelu C. Cutaneous sinuses of cervicofacial region: A clinical study of 200 cases. J Maxillofac Oral Surg. 2012; 11(4):411-5.
- Nair PN. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med. 2004; 15(6):348-81.
- Soares JA, de Carvalho FB, Pappen FG, Araújo GS, de Pontes Lima RK, Rodrigues VM, de Toledo Leonardo R. Conservative treatment of patients with periapical lesions associated with extraoral sinus tracts. Aust Endod J. 2007; 33(3):131-5.
- Mishra R, Khan TS. Cutaneous sinus tract in association with traumatic injury to the teeth. Int J Clin Pediatr Dent. 2013; 6(3):205-7.
Soo, E., Ramlan, N., Khairulzan, S., Nordin, R., & Rosli, M. The Successful Management of Non-healing Extraoral Draining Sinus of Odontogenic Origin: A Report of Two Cases. J Dent Indones. 2023;30(2): 136-140