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Chronic extra-oral cutaneous sinus infection in a child: case report Laura CU Ota Sara Chapman Mina Vaidyanathan Bethan Thomas Martin Woods Marielle Kabban Dental Update 2025 52:3, 182-184.
An extra-oral sinus is often assumed to be of non-odontogenic pathology and is rarely seen in paediatric patients, so inappropriate management often results. This case report highlights factors surrounding the diagnosis and treatment of extra-oral cutaneous sinus tracts as a manifestation of intra-oral pathology. Because this condition is rare, it is often misdiagnosed, which can result in inappropriate referrals (e.g. to dermatology teams, overtreatment with surgery or treatment with antibiotics), leading to recurrence. These patients should be referred to a specialist in paediatric dentistry for management. The importance of rigorous clinical investigation, appropriate referral and interdisciplinary management in paediatric patients is illustrated. In this case, elimination of dental infection led to complete resolution.
CPD/Clinical Relevance: Dental practitioners should consider infection of odontogenic origin as a differential diagnosis when a child presents with an extra-oral draining cutaneous sinus tract.
Article
A cutaneous sinus tract of odontogenic origin in the head and neck is rare in paediatric patients.1 An extra-oral sinus can be assumed to be of non-odontogenic pathology. However, it can be a sequel of a chronic infection owing to caries, trauma or periodontal disease.2 The resulting cytokine production and chronic inflammatory cell infiltration can lead to an exudate that drains via a sinus tract lined by epithelium or granulation tissue.3 A chronic peri-apical abscess is the main cause of odontogenic extra-oral cutaneous sinus tracts.4 This chronic inflammatory disorder of peri-radicular tissues is a sequela of pulpal necrosis, which leads to bacterial invasion of the surrounding periodontal ligament and bone. The resulting host-driven immune response to pathogens and inflammatory processes leads to alveolar bone resorption. This process continues until the cortex of bone and periosteum are breached. Then, depending on factors such as gravity, the virulence of the micro-organisms and anatomy of fascial spaces and musculature, either an intra-oral or extra-oral cutaneous sinus tract forms.4 The path of least resistance, through which infection travels, tends to be through alveolar bone draining intra-orally. The majority (80–87%) of extra-oral sinus tracts result from chronic infection related to mandibular teeth.5 The position of the root apex of a tooth relative to muscular attachments can also impact the route of drainage. In the mandible, when the infection destroys the outer cortical plate, if the suppurative exudate tracks below the level of the mentalis, mylohyoid or buccinator muscle attachments, it will form an extra-oral sinus.
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