Persistent submental fistula of odontogenic origin initially misdiagnosed as non-dental pathology - a case report.

INTRODUCTION

Persistent cutaneous fistulas of dental origin without intraoral symptoms can be diagnostically challenging, particularly when first assessed by non-dental clinicians. These fistulas are frequently misdiagnosed and inappropriately treated before the underlying dental cause is identified.

CASE PRESENTATION

We report the case of a 65-year-old female patient with a persistent submental fistula that had been unsuccessfully treated by several medical disciplines over several months. Initial conservative and surgical approaches failed to resolve the lesion. Dental examination revealed a periapical radiolucency associated with tooth 32, and subsequent CT imaging confirmed a cortical disruption suggestive of a fistulous tract. Surgical extraction of the affected tooth and excision of the inflammatory tissue resulted in resolution of the infection. Histopathology confirmed a chronically inflamed, partially cystic lesion. Secondary scar correction was performed for aesthetic reasons.

DISCUSSION

This case highlights the importance of including odontogenic causes in the differential diagnosis of chronic cutaneous facial lesions. Early dental imaging and interdisciplinary collaboration are essential for correct diagnosis and effective treatment. Psychological comorbidities and patient-related barriers, such as dental phobia, may further complicate management and delay recovery.

CONCLUSION

Persistent extraoral fistulas in the chin region should prompt a thorough dental evaluation. Appropriate radiographic imaging and timely surgical management can prevent unnecessary treatment and long-term complications. Increased awareness among non-dental clinicians is essential to avoid misdiagnosis.