Odontogenic Cutaneous Fistula: A Case in Aged Patient With Delayed Diagnosis

Abstract

Cases in which the CCF is draining posteriorly may be more challenging because of the smaller size of the SOV. Superficial collateral veins can be used to guide the dissection posteriorly. However, these blood vessels are prone to bleeding, and the importance of proper hemostasis throughout the procedure cannot be overemphasized. Alternatively, the SOV can be cannulated via a lateral orbitotomy when the anterior segment of the vein is out of reach or thrombosed.Complications are infrequent but may include orbital hemorrhage, infection, and damage to the trochlea or other orbital structures. 6,9 The inability to identify or cannulate the SOV remains a possibility. One of our patients (the second presented) developed an orbital compartment syndrome towards the end of the procedure, after the cannula was inadvertently dislodged from the SOV. The situation was quickly recognized, and the patients did not suffer from any related sequelae. CONCLUSIONIn our experience, the SOV provides a safe and effective access for endovascular embolization of indirect CCFs. Considering the inherent risks of orbital surgery, this approach should be reserved to patients in which all other options have been exhausted. The patient should also be monitored closely during the embolization process to prevent ophthalmic complications. ACKNOWLEDGMENTSWe would like to acknowledge the three patients presented in this study, who generously granted us permission to share their stories with the academic community.

Odontogenic Cutaneous Fistula: A Zombie Diagnosis

“…In elderly patients who might be edentulous, it is essential to remove the prosthesis to perform a proper oral examination. 1,2 In some cases, a cord like tract can be felt attached to the underlying bony structure. Further diagnostic tests include pulp sensitivity tests, percussion, and palpation to identify the affected tooth.…”

“…Many patients seek evaluation from several physicians before accurate diagnosis and treatment of oral cutaneous fistula, with more than half of patients undergoing multiple surgeries and trials of antibiotics before definitive diagnosis. 1,2 These cases summarized highlight the importance of communication between oral maxillofacial surgery, plastic surgery, other medical subspecialists, and dentists in the evaluation of patients with head and neck lesions. Furthermore, physicians should consider dental etiology in the differential diagnosis of orofacial skin lesions, even if teeth appear normal on oral examination.…”

“…These fistulas are most commonly associated with the mandibular teeth and the condition is more common among middle-aged and older adults. 2,4 Majority of oral cutaneous fistulas are reported to arise from chronic dental infection. A breach in the enamel and the dentine by a carious lesion, trauma, or other cause provides a portal for bacterial invasion.…”

“…1,5 Delay in treatment may result in chronic tissue injury as well as cosmetic deformities. 1,2,10 Once diagnosed, the treatment is simple and effective, consisting of the removal of the infected pulp tissue and filling of the root canal with biocompatible material, resulting in minimal scarring of the skin. 1 As lesions develop, they are often misdiagnosed, leading to delayed management.…”

“…An odontogenic cutaneous fistula is a pathologic communication between the cutaneous surface of the face and the oral cavity. These fistulas are most commonly associated with the mandibular teeth and the condition is more common among middle-aged and older adults 2,4 . Majority of oral cutaneous fistulas are reported to arise from chronic dental infection.…”