Odontogenic Cutaneous Fistula
A previously healthy 42-year-old woman presented to the dental clinic with a 6-month history of swelling and pain on the right side of her chin. She reported no history of chin trauma, tooth pain, or fevers but did recall injuring her right lateral incisor while playing basketball approximately 10 years before presentation. On physical examination, there was an area of skin dimpling with overlying scabbing on the right lower portion of the chin (Panel A). Palpation of the lesion caused pain and drainage of serosanguinous fluid. Intraoral examination was notable for slight discoloration of the mandibular right lateral incisor (Panel B, arrow). A radiograph of the teeth showed periapical rarefaction and osteolysis around that tooth (Panel C, asterisk). A diagnosis of odontogenic cutaneous fistula was made. Odontogenic cutaneous fistula is caused by chronic infection of the tooth root due to dental caries, periodontal disease, or tooth fracture, as was likely to have occurred in this case. The condition manifests as dimpling, a nodule, or a cyst on the chin, jaw, or elsewhere on the face. Misdiagnosis may occur because of the variable appearance and possible lack of dental symptoms. In this case, a root canal was performed, and at the 4-month follow-up, the fistula had healed (Panel D). Jianqiu Jin, M.D. Yuxing Zhang, M.D. Beijing Hospital, Beijing, China source: nejm.org