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Odontogenic skin sinus: A commonly overlooked skin presentation
Journal of Plastic, Reconstructive & Aesthetic Surgery (2012) 65, 1729e1730
CASE REPORT
Odontogenic skin sinus: A commonly overlooked skin presentation M.K. Herd*, T. Aldridge, S.D. Colbert, P.A. Brennan Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK Received 27 March 2012; accepted 9 April 2012
KEYWORDS Skin; Face; Chronic; Infection; Odontogenic; Tooth; Sinus
Summary Facial skin lesions present routinely to clinic and are largely dermatological in origin. Odontogenic infections are an unusual cause of facial lesion and are well-described in the dental literature; however they are regularly overlooked and mismanaged, often to considerable aesthetic detriment. We present such a case and highlight important avoidable pitfalls. ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
A 36-year old man presented with a chronic skin lesion which had been treated over a four year period by three episodes of surgical excision. The lesion presented over the point of the chin (Figure 1), recurred as soon as it was excised, and exhibited scarring with progressive skin indentation. Operative notes describe excision to bone on all occasions with pathology reporting only granulation tissue. Dental inspection at the start of his treatment indicated all teeth appeared healthy, however further questioning revealed a childhood incident where a swing had hit him in the face, but as no fracture occurred this was forgotten.
* Corresponding author. Tel.: þ44 2392 286099; fax: þ44 2392 286089. E-mail address: [email protected] (M.K. Herd).
Clinical tests showed his lower left canine tooth appeared healthy but had lost vitality. A plain film (Figure 2) demonstrated a periapical radiolucency indicating chronic dental infection which was further substantiated by a (previously requested) MRI scan (Figure 3) indicating inflammation surrounding the tooth. A diagnosis of chronic periapical periodontitis with chronic skin sinus was made. The patient was offered root canal treatment but opted for extraction with formal excision of sinus tract, which was curative, but is considering a formal complaint for delayed diagnosis and aesthetic detriment. Despite being described in dental literature,1 this case highlights several important lessons for any surgeon routinely treating skin lesions. Dentofacial infections are common and easily misdiagnosed unless formally considered. Dental infections may occur in the absence of tooth
1748-6815/$ - see front matter ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2012.04.009
1730
Figure 1 chin.
M.K. Herd et al.
Odontogenic sinus causing chronic skin lesion over Figure 3 MRI mandible indicating soft tissue lesion associated with lower left canine.
these types of infections to be serially excised causing adverse cosmetic outcome whereupon litigation may follow.
Conflict of interest None.
Funding Figure 2 Plain radiograph indicating lower left canine periapical radiolucency.
None.
Reference decay if a tooth is devitalised by trauma that interrupts the dental blood supply e this may occur years later. An MRI scan, though interesting, is an expensive and unjustified investigation for such pathology. It is very common for
1. Tidwell E, Jenkins JD, Ellis CD, Hutson B, Cederberg RA. Cutaneous odontogenic sinus tract to the chin: a case report. Int Endod J 1997;30:352e5.
CASE REPORT
Odontogenic skin sinus: A commonly overlooked skin presentation M.K. Herd*, T. Aldridge, S.D. Colbert, P.A. Brennan Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK Received 27 March 2012; accepted 9 April 2012
KEYWORDS Skin; Face; Chronic; Infection; Odontogenic; Tooth; Sinus
Summary Facial skin lesions present routinely to clinic and are largely dermatological in origin. Odontogenic infections are an unusual cause of facial lesion and are well-described in the dental literature; however they are regularly overlooked and mismanaged, often to considerable aesthetic detriment. We present such a case and highlight important avoidable pitfalls. ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
A 36-year old man presented with a chronic skin lesion which had been treated over a four year period by three episodes of surgical excision. The lesion presented over the point of the chin (Figure 1), recurred as soon as it was excised, and exhibited scarring with progressive skin indentation. Operative notes describe excision to bone on all occasions with pathology reporting only granulation tissue. Dental inspection at the start of his treatment indicated all teeth appeared healthy, however further questioning revealed a childhood incident where a swing had hit him in the face, but as no fracture occurred this was forgotten.
* Corresponding author. Tel.: þ44 2392 286099; fax: þ44 2392 286089. E-mail address: [email protected] (M.K. Herd).
Clinical tests showed his lower left canine tooth appeared healthy but had lost vitality. A plain film (Figure 2) demonstrated a periapical radiolucency indicating chronic dental infection which was further substantiated by a (previously requested) MRI scan (Figure 3) indicating inflammation surrounding the tooth. A diagnosis of chronic periapical periodontitis with chronic skin sinus was made. The patient was offered root canal treatment but opted for extraction with formal excision of sinus tract, which was curative, but is considering a formal complaint for delayed diagnosis and aesthetic detriment. Despite being described in dental literature,1 this case highlights several important lessons for any surgeon routinely treating skin lesions. Dentofacial infections are common and easily misdiagnosed unless formally considered. Dental infections may occur in the absence of tooth
1748-6815/$ - see front matter ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2012.04.009
1730
Figure 1 chin.
M.K. Herd et al.
Odontogenic sinus causing chronic skin lesion over Figure 3 MRI mandible indicating soft tissue lesion associated with lower left canine.
these types of infections to be serially excised causing adverse cosmetic outcome whereupon litigation may follow.
Conflict of interest None.
Funding Figure 2 Plain radiograph indicating lower left canine periapical radiolucency.
None.
Reference decay if a tooth is devitalised by trauma that interrupts the dental blood supply e this may occur years later. An MRI scan, though interesting, is an expensive and unjustified investigation for such pathology. It is very common for
1. Tidwell E, Jenkins JD, Ellis CD, Hutson B, Cederberg RA. Cutaneous odontogenic sinus tract to the chin: a case report. Int Endod J 1997;30:352e5.