The epithelized oral sinus tract

Salivary Metabolomics Fingerprint of Chronic Apical Abscess with Sinus Tract: A Pilot Study

Chronic apical abscess (CAA) is a lesion of apical periodontitis mostly characterized by areas of liquefactive necrosis with disintegrating polymorphonuclear neutrophils surrounded by macrophages. Its presence leads to local bacterial infection, systemic inflammatory response, pain, and swelling. The use of a novel approach for the study of CAA, such as metabolomics, seems to be important since it has proved to be a powerful tool for biomarkers discovery which could give novel molecular insight on CAA. So, the aim of this study was to verify the possibility to identify the metabolic fingerprint of CAA through the analysis of saliva samples. Nineteen patients were selected for this study: eleven patients affected by CAA with a sinus tract constituted the study group whereas eight patients without clinical and radiographic signs of CAA formed the healthy control group. Saliva samples were collected from each subject and immediately frozen at −80°C. Metabolomic profiles were obtained using a gas chromatography/mass spectrometry instrument. Subsequently, in order to compare the two groups, a multivariate statistical model was built that resulted to be statistically significant. The class of metabolites characterizing the CAA patients was closely related to the bacterial catabolism, tissue necrosis, and presence of a sinus tract. These preliminary results, for the first time, indicate that saliva samples analyzed by means of GC/MS metabolomics may be useful for identifying the presence of CAA, leading to new insights into this disease.

An uncommon cause for a non-healing cutaneous fistula in the parotid gland area - A case report

Introduction

Orocutaneous fistulae of dental origin are uncommon but well documented in the literature. This condition is often misdiagnosed because of the multiplicity of manifestations and the atypically presentation of the condition. Dental symptoms are rare. This makes diagnosis and treatment a challenging process.

Presentation of a case

A 67-year-old patient presented in the emergency room with an abscess in the parotid area. After incision and drainage the patient developed a non-healing fistula in the region of the parotid. Multiple treatment attempts and several investigations did not solve the problem. Finally, a panoramic x-ray showed a hidden, infected and displaced tooth in the right mandibular angle. After surgical extraction of the tooth and fistula excision, healing was uneventful and there was no recurrence.

Discussion

Given the diagnostic challenge, the real origin of the condition is frequently only discovered after several unnecessary interventions that may have harmed the patient. The key to early diagnosis is dental examination and dental radiographs. The goal of treatment is the elimination of the infection by surgical extraction of the tooth or non-surgical endodontic therapy.

Conclusion

Early diagnosis and rapid treatment minimize patient discomfort and reduce the probability of further complications. The differential diagnosis of sinus tract of dental origin should be considered in any case of unclarified non-healing skin lesion in the head and neck area, especially if initial treatments have failed. An early interdisciplinary approach is essential.

Histobacteriologic Conditions of the Apical Root Canal System and Periapical Tissues in Teeth Associated with Sinus Tracts

INTRODUCTION

This histobacteriologic study described the pattern of intraradicular and extraradicular infections in teeth with sinus tracts and chronic apical abscesses.

METHODS

The material comprised biopsy specimens from 24 (8 untreated and 16 treated) roots of teeth associated with apical periodontitis and a sinus tract. Specimens were obtained by periradicular surgery or extraction and were processed for histobacteriologic and histopathologic methods.

RESULTS

Bacteria were found in the apical root canal system of all specimens, in the main root canal (22 teeth) and within ramifications (17 teeth). Four cases showed no extraradicular infection. Extraradicular bacteria occurred as a biofilm attached to the outer root surface in 17 teeth (5 untreated and 12 treated teeth), as actinomycotic colonies in 2 lesions, and as planktonic cells in 2 lesions. Extraradicular calculus formation (mineralized biofilm) was evident in 10 teeth.

CONCLUSIONS

Teeth with chronic apical abscesses and sinus tracts showed a very complex infectious pattern in the apical root canal system and periapical lesion, with a predominance of biofilms.

Placental Membranes for Management of Refractory Cutaneous Sinus Tracts of Surgical Origin: A Pilot Study

Despite advances in surgical technique, postoperative complications may lead to refractory cutaneous sinus tracts or tunnels. Negative pressure wound therapy is difficult to apply in longer tracts with a narrow diameter opening and conservative treatment failures ultimately necessitate surgical revisions. The aim of this pilot study was a clinical utility assessment of two different commercial placental membrane products for refractory cutaneous sinus tracts of surgical origin. Patients were treated with viable cryopreserved placental membrane (vCPM, n = 6) or devitalized dehydrated amnion/chorion membrane (dHACM, n = 6). The primary outcome measurement was the proportion of complete sinus tract depth resolution without exudate. Secondary endpoints included 4-week percent reduction in sinus tract probing depth and peri-tract wound surface area, days and number of grafts to resolution, number of wound-related infections, and 1-year recurrence rate for closed sinus tracts. All vCPM patients demonstrated complete sinus tract resolution compared to zero closures in the dHACM group (p = 0.00216). The vCPM group achieved greater percent reduction in probing depth (73.3 ± 21.9 versus −4.4 ± 91.3) and surrounding wound surface area (34.8 ± 86.8 versus −279.3 ± 454.9) at 4 weeks than dHACM. The use of viable intact cryopreserved placental membrane has demonstrated positive clinical outcomes for the treatment for refractory exudative sinus tracts and may be an alternative to repeat surgical intervention.

Rare case of external dental fistula of the submental region misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst

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A relatively rare case of the cutaneous sinus tract in the submental region, derived from the lower second molar, was misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst.

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The patient previously underwent punch resection under local anesthesia, resulting in a histopathological diagnosis of inverted follicular keratosis.

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Computed tomography (CT) and fistulography indicated that the cutaneous lesion was linked to the periapex of the left mandibular second molar.

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Diagnostic imaging is essential in ensuring accurate assessment of the cause of cutaneous sinus tract.

Introduction

Odontogenic cutaneous sinus tract is a relatively rare occurrence that can be complicated to diagnose. The presence of a cutaneous lesion is often not even partly associated with a dental etiology because of the less frequency of occurrence in the case of dental symptoms. Consequently, the underlying dental cause is often missed leading to inappropriate diagnosis and treatment.

Case presentation

Here, we report the case of a 45-year-old man who presented with a persistent lesion of the cervical region. At the time of presentation, the lesion had been present for approximately one year with a gradual increase in size but no specific symptoms. The patient had previously undergone punch resection under local anesthesia, which resulted in a histopathological diagnosis of inverted follicular keratosis. A diagnosis was made of an odontogenic cutaneous sinus tract secondary to chronic apical periodontitis of the left mandibular second molar.

Discussion

Cutaneous sinus tract in the face and neck is most likely to develop intraorally. Root canal treatment or surgical extractions are the common treatment choices. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were treated by surgical or conservative nonsurgical endodontic therapy.

Conclusion

Early diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment.

Conservative management of persistent facial cutaneous sinus tract with a dental origin

Facial and cervical area sinus tracts can be odontogenic or non-odontogenic, and so clinicians should be aware that lesions with a dental origin can be confused with dermatological lesions. We describe three cases of cutaneous lesions of dental origin that were initially misdiagnosed as being dermatological in origin. Multiple unsuccessful treatments were attempted but the lesions failed to heal. However, conservative endodontic intervention resulted in complete resolution of the causative periapical lesions within a short period, making surgery unnecessary. Dental aetiology, as part of a differential diagnosis, must be considered in such oro-facial lesions.

Management of an endodontic infection with an extra oral sinus tract in a single visit: a case report

Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in good systemic health.

Submental Cutaneous Sinus Tract as a Result of Progressive Peri-Implantitis: A Case Report

BACKGROUND

The aim of the present case report was to define diagnosis and treatment options of a submental cutaneous sinus tract as a result of a progressive peri-implantitis around mandibular dental implants in a patient with a history of oral squamous cell carcinoma.

METHODS

Before the removal of the submental fistula, a panoramic radiograph and a computed tomography of the head and neck were assessed to identify the implants responsible for the cutaneous sinus tract and to exclude the presence of a tumor recurrence and lymph node metastases. The involved implants were removed, as there was a communication along them between the oral cavity and the cutaneous sinus tract resulting from progressive peri-implantitis. A histological examination of the excised fistula was carried out.

RESULTS

The histological examination excluded a recurrence of the oral squamous cell carcinoma. The fistula completely consisted of granulation tissue without epithelialization. After affected implants were removed, the wound healing was uneventful.

CONCLUSIONS

A panoramic radiograph is mandatory to identify the involved implants. Computed tomography, and excision of the fistula and a histological examination should be performed only in patients with a history of oral squamous cell carcinoma. Since the cutaneous sinus tract showed no epithelialization, it healed spontaneously after the removal of the responsible implants. Because of the large bony defect caused by progressive peri-implantitis leading to a communication of the oral cavity with the cutaneous sinus tract, more conservative treatment options with preservation of the implants could not be adopted in the present case.

Prevalence of odontogenic sinus tracts in patients referred for endodontic therapy

The purpose of this study was to determine the prevalence of odontogenic sinus tracts in patients referred for endodontic therapy. Charts of 330 patients (393 permanent teeth) endodontically treated during a 10-month period were reviewed and data was collected. Among the 393 permanent teeth there were a total of 160 teeth with preoperative status of periradicular inflammation. Of 160 teeth with preoperative status of periradicular inflammation, 29 teeth (18.1%) had an odontogenic sinus tract, which correlates to almost one in five teeth with periradicular inflammation having a sinus tract.

A case of an odontogenic cutaneous sinus tract

CASE REPORT

A 22-year-old female presented with a draining sinus tract on her left cheek. The tooth responsible was examined clinicopathologically. On clinical examination, the mandibular left first molar tooth was restored with an amalgam filling. Radiographic examination revealed base or pulp capping material below the restoration and a radiolucent periapical lesion surrounding the distal root apex. Conservative non-surgical root canal treatment was performed; 10 months later, the sinus had healed completely and the periapical lesion had resolved. Histopathological examination of pulp tissue recovered during treatment revealed foreign bodies, made up of capping material and amalgam, associated with chronic inflammation. These findings suggested that chronic inflammation in the pulp tissue had resulted in a draining sinus tract.

Epithelial lining of sinus tracts associated with periapical disease: an immunocytochemical study using monoclonal antibodies to keratins

We examined 30 specimens of mucosal sinus tracts arising in association with periapical inflammation. Immunocytochemistry and a panel of monoclonal antibodies to keratins were used to demonstrate the epithelial lining and its pattern of keratin expression. Half of the specimens were found to have an epithelial lining that was continuous with the mucosal epithelium and showed various degrees of extension into the sinus. The presence of an epithelial lining appeared to correlate with the duration of the sinus tracts. The immunostaining patterns of the epithelial linings were similar to those of the mucosal epithelium near the sinus opening although some differences were found. Proliferating strands of epithelium, presumably derived from the rest of Malassez, were observed deep in the tissues but were not continuous with the epithelial lining. The results suggest that the epithelial lining of sinus tracts is derived not from epithelial rests in the periapical region but from the mucosal epithelium adjacent to the opening of the sinus tract and that the observed changes in the pattern of keratinization are due to the influence of inflammation or of the connective tissue substrate.

The diagnosis and management of vertical bony defects

Marginal periodontitis and pulpal disease often cause similar-appearing lesions in the periodontium. Successful therapy depends on correct diagnosis, which is sometimes difficult. Some bony defects caused by pulpal disease require surgical debridement in addition to standard endodontic therapy. With one exception three-walled intrabony periodontal defects discussed in this report were managed by surgical debridement without any type of implant or graft. Long-term observation is required to determine the value of techniques used in the treatment of intrabony periodontal defects.