Cutaneous and Mucous Sinus Tract of Dental Origin: What’s Behind it?

Dental Sinus Tract is an inflammatory channel putting in communication a deep peri-dental suppurative lesion with an exit orifice, it’s nature’s method of establishing drainage. A general practitioner commonly encounters in his practice this type of lesion. However, their discovery is very often delayed due to their chronic nature (asymptomatic) and their localization (hidden in the mucous folds or in skin furrows). The aim of this clinical case reports is to dissect the diagnostic difficulties and to discuss the therapeutic particularities of the management of mucous and cutaneous fistulas of dental origin. the first patient was referred to our service for the extraction of an impacted canine in whom we discovered by chance a mucous fistula that hides a cystic lesion perforating the vestibular alveolar table, after 2 weeks of intracanal calcium hydroxide and a root canal obturation, periapical surgery was performed with apical resection and 3 mm MTA plug. the second patient was referred by the maxillofacial department to verify a possible dental origin for the drainage of the cutaneous sinus tract in the left posterior part of the cheek, the radiographic analysis shows a decayed 36 with diffuse radiolucency and a resorbed distal root. The tooth was judged to be preserved and after root canal instrumentation and calcium hydroxide medication, the skin lesion shows signs of healing, therefore, the root canal filling was made with a bio-ceramic sealer and the patient was put under control. The key to the success of the treatment of mucous and cutaneous sinus tract of dental origin is, first of all, to know how to identify the etiology to their existence in order to not misdiagnose and initiate inappropriate therapies and, secondly, to be aware of the importance of post-operative follow-up. Finally, the treatment of the dental cause, conservative or not, leads generally to the disappearance of the fistula and a regression of the symptoms.