Cutaneous dental sinus tracts are communications that allow draining of purulence from the oral cavity onto the skin surface. The most common cause is a chronic periapical abscess arising from a bacterial infection (caries), chemical irritation, or trauma. Pulp necrosis with chronic inflammation eventually spreads to the periodontal ligament and alveolar bone. Inflammation with abscess formation continues until perforating through the cortical bone, spreading through surrounding soft tissues, and finally erupting on the skin.
These sinus tracts occur more commonly in adults but may also be seen in children and adolescents.
Involvement of the mandibular first molars is most common in children. In contrast, the mandibular incisors are most commonly involved in adults, likely due to higher likelihood of physical activities that may result in trauma. The location of cutaneous sinus tracts will differ depending on the teeth involved.
These lesions are usually painless and without edema because continuous drainage prevents fluid accumulation and pressure. However, there may be a history of fever, pain, swelling, and intraoral drainage prior to the development of the sinus tract to the cutaneous surface.
Culturing of exudate has revealed a mix of obligate and facultative anaerobic bacteria, including Staphylococcus epidermidis, Bacteroides melaninogenicus, and Fusobacterium, Peptostreptococcus, and Veillonella species.
Cutaneous dental sinus tract - Oral Mucosal Lesion
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Synopsis
Codes
ICD10CM:
K04.6 – Periapical abscess with sinus
SNOMEDCT:
472978005 – Orocutaneous fistula
K04.6 – Periapical abscess with sinus
SNOMEDCT:
472978005 – Orocutaneous fistula
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Last Reviewed:08/14/2019
Last Updated:05/06/2021
Last Updated:05/06/2021
Cutaneous dental sinus tract - Oral Mucosal Lesion
See also in: Cellulitis DDx