Rare case of external dental fistula of the submental region misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst

Toshihisa Sato; Hideyuki Suenaga; Masaki Igarashi; Kazuto Hoshi; Tsuyoshi Takato

doi:10.1016/j.ijscr.2015.08.042

Rare case of external dental fistula of the submental region misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst

Int J Surg Case Rep. 2015:16:39-43. doi: 10.1016/j.ijscr.2015.08.042. Epub 2015 Sep 18.

Authors

Toshihisa Sato¹, Hideyuki Suenaga², Masaki Igarashi¹, Kazuto Hoshi¹, Tsuyoshi Takato¹

Affiliations

¹ Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Japan.
² Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Japan. Electronic address: suenaga-tky@umin.ac.jp.

Abstract

Introduction: 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.

Case presentation: 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.

Discussion: 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.

Conclusion: Early diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment.

Keywords: Cutaneous dental sinus tract; Dental etiology; Dental pulp necrosis; Inverted follicular keratosis; Misdiagnosis; Root canal treatment; Surgical extractions; Thyroglossal duct cyst.