A clinical predicament- Extraoral cutaneous sinus tract of dental origin

Abstract

Introduction: Extra oral cutaneous sinus tracts are generally misdiagnosed because of absence of dental symptoms. In this case report we have treated a 12-year-old patient, initially misdiagnosed and treated as a skin lesion by the physician. Once the accurate diagnosis of dental origin was made, definitive treatment through conventional root canal therapy reduced the incidence of complications. Case Description: He had a painless erythematous nodule present for the past 3months extra orally. It was soft on palpation and elicited a purulent discharge. Intra oral examination revealed carious lesion in mesio-occlusal aspect of left mandibular first molar. Radiographic examination revealed pulp involvement and periapical radiolucency. He was diagnosed with a non-vital mandibular molar with chronic apical periodontitis and a draining extra oral sinus. Endodontic intervention was performed with intracanal medicament placed for two weeks. During final visit, root canals were obturated. There was resolution of sinus tract with minimal scar after 7months. 15 months follow up showed scar completely resolved extra orally. Discussion: Several case reports reveal that if appropriate diagnosis could not be made, incorrect treatment causes cutaneous sinus tract to reoccur. This scientific paper aims to present a dental literature review of cutaneous sinus tracts having dental origin and to report a case treated successfully by non-surgical conservative endodontic therapy. Conclusion/Clinical Significance: Extra oral cutaneous sinus tracts are rare entity, hard to diagnose unless the treating clinician considers the possibility of its dental origin. Proper management curbs the disease progression and protects patient from emotional upheaval.