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fistula often presents with facial sinus, and patients visit dermatology
clinics. Usually, diagnosis is not
difficult by orthopantomography. We present a case of external dental fistula
which was not detected by orthopantomography, but examination by cone-beam
computed tomography (CT) revealed a small sequestrum.
A 62-year-old woman was referred to our hospital, complaining of a nodular lesion on her right cheek, with 2 months’ duration. Previously, she visited otolaryngology department, and needle biopsy showed no malignancy. Administration of antibiotics resulted in no effects. On the initial visit to our department, a physical examination showed a reddish dimpled nodule located on the right cheek (Figure 1). Clinical diagnosis was external dental fistula, however, examination by pantomography did not detect any abnormalities. Histological examination showed non-specific granulation with dense infiltration of inflammatory cells composed of lymphocytes, neutrophils, histiocytes and plasma cells in the whole dermis (Figure 2). Tissue cultures for bacteria, mycobacterium tuberculosis and non-tuberculous mycobacterium were all sterile. Also, polymerase chain reaction (RCR) analysis for mycobacterium tuberculosis and non-tuberculous mycobacterium were negative. Laboratory examination showed no abnormalities including liver and kidney function, and tuberculin test revealed negative reaction. Cone-beam computed tomography revealed the presence of a small sequestrum (Figure 3). Surgical treatment with sequestrectomy resulted in improvement with scar within 3 months.
1. Wilson SW, Ward DJ, Burns A (2001) Dental infections masquerading as skin lesions. Br J Plast Surg 54: 358-360. PMID: 11355994
2. Patel S, Kanagasingam S, Mannocci F (2010) Cone beam computed tomography (CBCT) in endodontics. Dent Update 37: 373-379. PMID: 20929151
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