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Oral Cutaneous Fistulas Clinical Presentation

  • Author: James E Cade, DDS; Chief Editor: William D James, MD  more...
 
Updated: Sep 03, 2015
 

History

Acute dental infections cause extreme pain when they occur in a confined area. The pulp is confined in a hard structure, namely, the pulp chamber. Most nerve receptors in the tooth are type A delta nerve fibers, which detect pain sensation. These fibers interpret the pressure due to edema in infection and inflammation as pain.

Acute periapical inflammation also causes pain when it is confined to a bony space.

Pain often decreases or disappears when a sinus tract forms, relieving pressure.

In chronic osteomyelitis with drainage, pain may not be a symptom.

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Physical

An intraoral sinus tract or parulis may be raised or appear as a red-to-yellow ulcer that bleeds easily and exudes pus.

If infection from the mandible remains confined to the oral cavity or if the infection spreads to the skin, the site of fistulation may be distant from the intraoral infection site.

In some cases of actinomycosis, yellow granules (often called sulfur granules) are observed at clinical examination. These granules have a characteristic histologic appearance.

Signs and symptoms of salivary gland infections include swelling, pain, and trismus if the parotid gland is involved. Major salivary gland fistulas are diagnosed by means of probing or sialography.

A thorough head and neck examination including palpation of head and neck lymph nodes is needed to rule in or out dental infections verses other dematological infections and neoplasms..

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Causes

Poor oral hygiene and trauma cause most dental infections.

Compared with other individuals, patients who are immunocompromised, those who are receiving chemotherapy, and those with blood dyscrasias are more likely to have dental infections.

Xerostomia leads to additional caries due to increased salivary acidity. This effect enhances the growth of cariogenic bacteria and increases the adherence of plaque to the teeth.

Gram-positive bacteria and gram-negative microorganisms such as Streptococcus mutans; Staphylococcus epidermidis; S aureus; and Porphyromonas, Actinomycoses, Bacteroides, and Fusobacterium species are found in dental infections and periodontal infections.

Reportedly, an occult root fracture that resulted from excessive endodontic sealer caused an infection and a chronic fistula lasting more than a year. When the root fracture was discovered and treated, the cutaneous sinus resolved within 1 month.[28]

Bisphosphonates and other antiangiogenic medications for the treatment of osteoporosis, steroid therapy, and neoplasms in or invading bone may reduce blood supply increasing infection potential of the jaws.

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Contributor Information and Disclosures
Author

James E Cade, DDS Associate Professor, Meharry Medical College

James E Cade, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Maureen B Poh-Fitzpatrick, MD Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, New York Dermatological Society

Disclosure: Nothing to disclose.

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Cutaneous fistula due to a dental infection that causes Ludwig angina. Courtesy of Alexander Pazoki, DDS, LSU School of Dentistry, New Orleans, La.
Gunshot wound causing an oral cutaneous fistula. Courtesy of Alexander Pazoki, DDS, LSU School of Dentistry, New Orleans, La.
Squamous cell carcinoma causing an oral cutaneous fistula. Courtesy of Alexander Pazoki, DDS, LSU School of Dentistry, New Orleans, La.
Squamous cell carcinoma of the sinus that penetrates the maxillary ridge.
 
 
 
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