The epithelized oral sinus tract

doi:10.1016/0030-4220(76)90299-1

Oral Surgery, Oral Medicine, Oral Pathology

Volume 42, Issue 4, October 1976, Pages 511-517

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(76)90299-1 Get rights and content

Abstract

Sinus tracts that extended from periapical lesions to the alveolar mucosa were surgically removed and examined microscopically. The results indicate that sinus tracts may be lined with stratified squamous epithelium. More commonly, however, these tracts are lined with granulation tissue.

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I.B. Bender et al.
The Oral Fistula: Its Diagnosis and Treatment
Oral Surg
(1961)
R.F. Sommer et al.
Clinical Endodontics

There are more references available in the full text version of this article.

Cited by (27)

Ultrasound Examination to Visualize and Trace Sinus Tracts of Endodontic Origin
2019, Journal of Endodontics
Citation Excerpt :
The difficulty in the healing of STs has been explained in the past with the presence of an epithelial lining throughout the tract8,30, which would hamper the closure of the pathologic pathway despite the adequate treatment of the root canal infection. Epithelialization as the cause of failure has been dispelled by the evidence that the persistence of infection was a more important reason for the lack of resolution of the ST11,31. Concentrations above the average of specific pathogens in intraradicular infection have been considered responsible for the poorer prognosis of teeth with chronic apical abscesses; yet, no significant differences were found between cases with and without STs in terms of total bacterial counts32.
The detection of a tooth with a sinus tract (ST) of endodontic origin and its pathway are conventionally assessed with a periapical radiograph and a gutta-percha cone introduced into its stoma. The aim of this study was to evaluate the possibility to detect STs and trace their route using ultrasound real-time examination.
Two calibrated examiners performed echography on 10 patients who had a lesion of apical periodontitis (AP) and ST and 10 patients in the control group with AP without an ST recruited in 2 endodontic practices. They also traced the pattern of the STs with a computer program. The images were then submitted to 2 calibrated and blinded observers who were asked to describe the presence of AP and ST and to trace it with the same program. The data obtained were compared with the clinical and radiographic diagnosis of ST. For sensitivity, specificity, accuracy, and positive and negative predictive values, the receiver operating characteristic curve and Fisher exact test were used (P < .05).
Interobserver agreement was high as was the diagnostic accuracy of the ultrasound examination of STs (mean value = 97.5%), and the Fisher exact test showed statistical significance (P < .05). High sensitivity and a negative predictive value and 100% specificity and a positive predictive value were also obtained. The application of the 3-dimensional mode further enabled the reconstructions of the more complex paths, and the implementation with color power Doppler disclosed the vascularity surrounding the STs.
The ultrasound examination is a technique feasible to describe and trace the STs of endodontic origin.
An uncommon cause for a non-healing cutaneous fistula in the parotid gland area - A case report
2018, Annals of Medicine and Surgery
Citation Excerpt :
A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were solved by surgical or conservative nonsurgical endodontic therapy [14]. Some earlier studies suggested that the sinus tract is lined with epithelium and propose surgical extraction of the tooth to achieve healing [15]. Subsequent studies have demonstrated that the sinus tract is often lined with granulation tissue, indicating that it can be treated by nonsurgical root canal therapy [16,17].
Orocutaneous fistulae of dental origin are uncommon but well documented in the literature. This condition is often misdiagnosed because of the multiplicity of manifestations and the atypically presentation of the condition. Dental symptoms are rare. This makes diagnosis and treatment a challenging process.
A 67-year-old patient presented in the emergency room with an abscess in the parotid area. After incision and drainage the patient developed a non-healing fistula in the region of the parotid. Multiple treatment attempts and several investigations did not solve the problem. Finally, a panoramic x-ray showed a hidden, infected and displaced tooth in the right mandibular angle. After surgical extraction of the tooth and fistula excision, healing was uneventful and there was no recurrence.
Given the diagnostic challenge, the real origin of the condition is frequently only discovered after several unnecessary interventions that may have harmed the patient. The key to early diagnosis is dental examination and dental radiographs. The goal of treatment is the elimination of the infection by surgical extraction of the tooth or non-surgical endodontic therapy.
Early diagnosis and rapid treatment minimize patient discomfort and reduce the probability of further complications. The differential diagnosis of sinus tract of dental origin should be considered in any case of unclarified non-healing skin lesion in the head and neck area, especially if initial treatments have failed. An early interdisciplinary approach is essential.
Histobacteriologic Conditions of the Apical Root Canal System and Periapical Tissues in Teeth Associated with Sinus Tracts
2018, Journal of Endodontics
This histobacteriologic study described the pattern of intraradicular and extraradicular infections in teeth with sinus tracts and chronic apical abscesses.
The material comprised biopsy specimens from 24 (8 untreated and 16 treated) roots of teeth associated with apical periodontitis and a sinus tract. Specimens were obtained by periradicular surgery or extraction and were processed for histobacteriologic and histopathologic methods.
Bacteria were found in the apical root canal system of all specimens, in the main root canal (22 teeth) and within ramifications (17 teeth). Four cases showed no extraradicular infection. Extraradicular bacteria occurred as a biofilm attached to the outer root surface in 17 teeth (5 untreated and 12 treated teeth), as actinomycotic colonies in 2 lesions, and as planktonic cells in 2 lesions. Extraradicular calculus formation (mineralized biofilm) was evident in 10 teeth.
Teeth with chronic apical abscesses and sinus tracts showed a very complex infectious pattern in the apical root canal system and periapical lesion, with a predominance of biofilms.
Placental Membranes for Management of Refractory Cutaneous Sinus Tracts of Surgical Origin: A Pilot Study
2016, Journal of the American College of Clinical Wound Specialists
Citation Excerpt :
Histologic evaluation of excised sinus tracts reveal that the majority are lined with granulation tissues containing chronic inflammatory cells, while 10% are lined with stratified squamous epithelium.15 Both tissue types contribute to development of tracts that are recalcitrant in nature, thereby rendering them clinically indistinguishable; however, the removal of an epithelial lining has been shown to reduce recurrence.9,15 The initial treatment approach for exudative tracts is conservative, historically involving gauze or gauze ribbon packing.
Despite advances in surgical technique, postoperative complications may lead to refractory cutaneous sinus tracts or tunnels. Negative pressure wound therapy is difficult to apply in longer tracts with a narrow diameter opening and conservative treatment failures ultimately necessitate surgical revisions. The aim of this pilot study was a clinical utility assessment of two different commercial placental membrane products for refractory cutaneous sinus tracts of surgical origin. Patients were treated with viable cryopreserved placental membrane (vCPM, n = 6) or devitalized dehydrated amnion/chorion membrane (dHACM, n = 6). The primary outcome measurement was the proportion of complete sinus tract depth resolution without exudate. Secondary endpoints included 4-week percent reduction in sinus tract probing depth and peri-tract wound surface area, days and number of grafts to resolution, number of wound-related infections, and 1-year recurrence rate for closed sinus tracts. All vCPM patients demonstrated complete sinus tract resolution compared to zero closures in the dHACM group (p = 0.00216). The vCPM group achieved greater percent reduction in probing depth (73.3 ± 21.9 versus −4.4 ± 91.3) and surrounding wound surface area (34.8 ± 86.8 versus −279.3 ± 454.9) at 4 weeks than dHACM. The use of viable intact cryopreserved placental membrane has demonstrated positive clinical outcomes for the treatment for refractory exudative sinus tracts and may be an alternative to repeat surgical intervention.
Rare case of external dental fistula of the submental region misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst
2015, International Journal of Surgery Case Reports
Citation Excerpt :
The key to successful treatment is ensuring adequate measures to eliminate intracanal microorganisms. Early studies demonstrated that these sinus tracts were lined with epithelium, suggesting that surgical intervention was necessary to ensure recovery [15]. However, subsequent studies have demonstrated that the sinus tract is lined with granulation tissue, indicating that they can be treated with nonsurgical root canal therapy [13,16].
Odontogenic cutaneous sinus tract is a relatively rare occurrence that can be complicated to diagnose. The presence of a cutaneous lesion is often not even partly associated with a dental etiology because of the less frequency of occurrence in the case of dental symptoms. Consequently, the underlying dental cause is often missed leading to inappropriate diagnosis and treatment.
Here, we report the case of a 45-year-old man who presented with a persistent lesion of the cervical region. At the time of presentation, the lesion had been present for approximately one year with a gradual increase in size but no specific symptoms. The patient had previously undergone punch resection under local anesthesia, which resulted in a histopathological diagnosis of inverted follicular keratosis. A diagnosis was made of an odontogenic cutaneous sinus tract secondary to chronic apical periodontitis of the left mandibular second molar.
Cutaneous sinus tract in the face and neck is most likely to develop intraorally. Root canal treatment or surgical extractions are the common treatment choices. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were treated by surgical or conservative nonsurgical endodontic therapy.
Early diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment.
Diagnosis
2010, Cohen's Pathways of the Pulp, Tenth Edition

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^☆: This investigation was funded by Clinical Research Service, Madigan Army Medical Center.

^∗: Director, Endondontic Residency Training Program, and Chief, Endodontic Service.

^∗∗: Chief, Oral Pathology.

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The epithelized oral sinus tract☆

Abstract

The Oral Fistula: Its Diagnosis and Treatment

Oral Surg

Clinical Endodontics