Submental cutaneous sinus tract of mandibular second molar origin.

AIM

To report a case in which a submental cutaneous sinus tract resulted from apical periodontitis associated with a mandibular second molar.

SUMMARY

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.

KEY LEARNING POINTS

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.