Oral Cutaneous Fistulas Workup

  • Author: James Cade, DDS; Chief Editor: William D James, MD   more...
 
Updated: Aug 5, 2011
 

Laboratory Studies

  • Culture and sensitivity testing and, in selected cases, DNA probe testing may be used to identify the causative organism and determine treatment.
  • Serious dental infections may increase the erythrocyte sedimentation rate and neutrophil count. With chronic infections, lymphocyte and monocyte counts may subsequently increase.
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Imaging Studies

  • In chronic periapical infections, a well-circumscribed radiolucency may be observed radiographically; however, in early infections, radiographic evidence may not be observed.
  • On radiographs, osteomyelitis appears as an area of radiolucency, radiopacity, or mixed radiolucency with poorly defined borders. The mandible is most commonly involved. These findings are also present in osteoradionecrosis
  • Unless the infection is rampant and severe, imaging studies such as a CT scanning or MRI usually are not necessary. If infection persists despite therapy, CT scanning and MRI may be necessary to determine its extent and to rule out a neoplastic cause. Computer-aided rapid prototyping in a 3-dimensional format with CT scans was reported to analyze each tooth root to aid in nonsurgical root canal therapy.[23]
  • Panoramic radiographs, lateral jaw plain radiographs, Waters radiographs, or periapical radiographs may be necessary for diagnosis and treatment, depending on the location and extent of the infection.
  • With oral antral and oral nasal fistulas, cloudy sinuses may be observed on panoramic or Waters radiographs. Radiographs occasionally show a break in the antral or nasal floor. If the opening to the palate is large enough, nasal speech occurs.
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Procedures

  • The possibility of a neoplastic cause may require biopsy.
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Histologic Findings

With acute infection, histologic sections show a preponderance of neutrophils and necrotic debris. Chronic infections are histologically characterized by numerous plasma cells, lymphocytes, and macrophages; often, a proliferation of blood vessels and connective tissue or granulation tissue is present.

In chronic osteomyelitis, sections of acellular bone are present, sometimes with little inflammatory infiltrate. When histologic sections are processed, decalcification of the specimen for sectioning can remove lacunar cells present in bone. This effect must be considered when histologic sections of bone are viewed.

Actinomycosis has characteristic pseudohyphae appearing as clublike projections that stretch out from a central basophilic-staining core. The absence of this finding does not rule out an actinomycotic infection.

Microscopic sections of mucoceles show minor salivary glands with chronic inflammation and a granulation wall that surrounds a pool of mucin.

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Contributor Information and Disclosures
Author

James Cade, DDS  Clinical Dentist, Honeycutt Family Dentistry

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Maureen B Poh-Fitzpatrick, MD  Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons; Professor of Medicine (Dermatology), University of Tennessee Health Science Center College of Medicine

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

Disclosure: Lundbeck, Inc. Honoraria Review panel membership; Clinuvel Pharmaceuticals, Ltd. Honoraria Consulting

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

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

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

Disclosure: Elsevier Royalty Other

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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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