Management of an Endodontic Infection with an Extra Oral Sinus Tract in a Single Visit: A Case Report

Abstract

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.

Single-visit endodontic treatment of mature teeth with chronic apical abscesses using mineral trioxide aggregate cement: a randomized clinical trial

“…Recent publications have mainly been case reports treating mature teeth with chronic apical abscesses in multiple-visits with intra-canal medicament [9], or with the use of chlorhexidine irrigant [8], and the follow-up time was less than 2 years. Therefore, the treatment outcomes of this study cannot be compared directly to previous publications.…”

Extraoral cutaneous sinus tracts of dental origin in the paediatric patient. A report of three cases and a review of the literature

“…The aetiology of an extraoral sinus tract of odontogenic origin within the face and neck region has been cited as resulting primarily as result of caries and subsequent pulpal necrosis [1][2][3][4][5][6][7][8]11,14 , secondarily as a consequence of trauma-related pulpal necrosis 1,4,5,[10][11][12][13]15 and rarely, as a result of a periodontal infection 13,15 . In the case of odontogenic-related extraoral sinus lesions, the infection is usually chronic in nature and therefore presentation is delayed 4 often resulting in misdiagnosis of the causative factor [1][2][3][4][5][6][7][8][9][10]16,17 .…”

“…The odontogenic infection might initially be localized and present as a periapical or peri-odontal abscess [1][2][3][5][6][7][8][9][10][11][12][14][15][16][18][19][20] before spreading into the surrounding tissues. The sequelae of the resulting infection will depend on (i) the regional anatomy, (ii) virulence of the bacteria, and (iii) host resistance factors [1][2][3][5][6][7][8][10][11][12]21 .…”

“…In the case of extraoral sinus tracts, the infection can spread diffusely beyond the confines of the oral cavity into the surrounding tissues through the fascial planes along the path of least resistance 1,2,5,6,11,19 . The position of the affected tooth and the root apex location in terms of anatomy will determine the likely appearance of the infection as an intra-or extraoral presenting sinus 1,3,5,[10][11][12]19 . In the maxilla, swelling will initially present to the upper half of the face and may drain extraorally if the infection perforates the outer cortical plate.…”

“…Extraoral cutaneous sinus tracts of odontogenic origin can unfortunately often be misdiagnosed due to the unexpected appearance of the lesion without historic odontogenic pain, discomfort, or cellulitis [1][2][3][4][5][6][7][8][9][10][11]16,17 . The clinician must ensure that a thorough and careful history is obtained to aid diagnosis when a paediatric patient presents with an extraoral swelling [5][6][7]12,16,18 .…”