Bai J, Ji A-P, Huang M-W
Department of Oral Emergency, Peking University School and Hospital of Stomatology, Beijing, China.
Int Endod J. 2014 Dec;47(12):1185-91. doi: 10.1111/iej.12266. Epub 2014 Mar 21.
To report a case in which a submental cutaneous sinus tract resulted from apical periodontitis associated with a mandibular second molar.
A 53-year-old man presented with a chronic cutaneous sinus tract in the submental region, which had previously been misdiagnosed as a thyroglossal fistula. The origin of the sinus tract was shown by sinus tract angiography to be the left mandibular second molar (tooth 37), which had apical periodontitis. The sinus tract healed after extraction of the tooth and partial excision of the lesion from an extraoral approach. Histological examination confirmed that the tract was lined with granulation tissue and not with epithelial tissue. A submental sinus tract drainage pathway was observed. Prompt dental evaluation, especially of all mandibular teeth, should be considered when assessing cases of submental cutaneous sinus tracts.
An odontogenic origin should be part of the differential diagnosis for orofacial skin lesions. Cutaneous sinus tracts of mandibular molar origin are complex and thus a comprehensive examination should be stressed. It is necessary to examine all mandibular teeth in cases of odontogenic submental cutaneous sinus tracts. Sinus tract angiography can be used to identify the sinus tract pathway and to confirm the associated teeth. The treatment of an odontogenic cutaneous sinus tract requires the elimination of the source of infection.
报告1例由下颌第二磨牙根尖周炎引起的颏下皮肤窦道病例。
一名53岁男性患者颏下区域出现慢性皮肤窦道，此前曾被误诊为甲状舌管瘘。通过窦道血管造影显示，窦道起源于患有根尖周炎的左下颌第二磨牙（37号牙）。拔牙并经口外途径部分切除病变后，窦道愈合。组织学检查证实，窦道内衬肉芽组织而非上皮组织。观察到一条颏下窦道引流途径。在评估颏下皮肤窦道病例时，应考虑及时进行牙科评估，尤其是对所有下颌牙齿的评估。
牙源性病因应作为口面部皮肤病变鉴别诊断的一部分。下颌磨牙源性皮肤窦道情况复杂，因此应强调全面检查。对于牙源性颏下皮肤窦道病例，有必要检查所有下颌牙齿。窦道血管造影可用于确定窦道途径并确认相关牙齿。牙源性皮肤窦道的治疗需要消除感染源。
