Sir,
We would like to report an interesting case of a 12-year-old child who reported to the dental clinic with a complaint of pain in the left lower jaw posteriorly. Intraoral examination revealed a large carious lesion associated with the mandibular left first molar. The tooth was tender on percussion. An orthopantamogram (OPG) revealed periapical radiolucency in relation to the mandibular left first molar. Because the patient belonged to a low socioeconomic background, root canal treatment was not financially feasible. Hence, the tooth was extracted under local anesthesia. Healing was uneventful. Three months later the patient was referred back to our dental clinic by a dermatologist with complaint of a draining sinus on the lower left side of the face [Figure 1]. The discharge was purulent. The dermatologist had been treating the patient with oral amoxicillin and a topical antiseptic cream for 1 month.
Figure 1.
(a) Extraoral photograph of the patient showing a draining sinus on the lower left side of the face. (b) Intraoral picture showing a completely healed extraction wound
A CBvi was advised along with an OPG [Figure 2]. The OPG showed a healing extraction socket while the CBvi showed an extraction tooth socket with a sinus tract perforating the lingual cortex. A sample of the discharge was sent for culture and antibiotic sensitivity. The culture was positive for Pseudomonas aeruginosa and Enterococcus species, and the organisms were sensitive to ciprofloxacin. A culture for acid fast bacilli was negative after 6 weeks of incubation. The extraoral sinus tract was debrided and cleaned and the patient was put on oral ciprofloxacin. The sinus tract healed within 2 weeks of the treatment with no scarring [Figure 3].
Figure 2.
Orthopantamogramshowing the healing extraction socket
Figure 3.
Extraoral photograph of the healed sinus tract after treatment with no scar formation
It is common for practitioners to misdiagnose the cause of cutaneous sinus tracts on face, and they usually fail to recognize that the cause may be odontogenic. Any long standing infection around the apex of the root of a tooth can drain into the mouth or less commonly into the skin via a sinus tract.[1] Patients assume that the sinus tract may not be related to a dental infection and may seek the help of a dermatologist or their family physician.[2] In the present case, the patient visited the dermatologist for the draining sinus tract assuming it to be of a nondental origin. Any topical therapy provided due to the misdiagnosis can result in delayed healing of the wound and lead to recurrence. The sinus tract healed uneventfully after the change in the antibiotics thus emphasizing the need for a thorough dental evaluation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
References
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