Case and Research Letters
Diagnostic Value of Color Doppler Ultrasound for Cutaneous Odontogenic Sinus Tract
Utilidad de la ecografía doppler color para el diagnóstico de fístulas dentocutáneas
C. Garrido Colmenero
, G. Blasco Morente, J.M. Latorre Fuentes, R. Ruiz Villaverde
Corresponding author
Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Virgen de las Nieves, Granada, Spain
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Garrido Colmenero, G. Blasco Morente, J.M. Latorre Fuentes, R. Ruiz Villaverde" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Garrido Colmenero" "email" => array:1 [ 0 => "cristinagarrido86@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Blasco Morente" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Latorre Fuentes" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz Villaverde" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Virgen de las Nieves, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía doppler color para el diagnóstico de fístulas dentocutáneas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1251 "Tamanyo" => 381212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous horn sunken into the skin over the left horizontal ramus of the mandible.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 32-year-old man with no past history of interest. He was seen in dermatology outpatients for a tumor in the form of a cutaneous horn sunken into the skin over the left horizontal ramus of the mandible (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Examination revealed no alterations of the oral cavity. The patient stated that the region was tender. He had applied topical treatment with 2% mupirocin ointment without improvement. B mode skin ultrasound (Esaote, Genoa, Italy) using an 18<span class="elsevierStyleHsp" style=""></span>MHz probe revealed a slightly tortuous, relatively well-defined, hypoechoic linear structure that extended to the surface of the cortical bone of the mandible (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Doppler study showed blood vessels in the area around the tract, suggestive of inflammation, and a poorly defined hypoechoic outline in B mode (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). With a diagnosis of cutaneous odontogenic sinus, the patient was referred to the maxillofacial surgery department, where the study was completed with orthopantomography. This x-ray study revealed a radiolucent image that surrounded the apex of the posterior root of the left first molar (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Conservative treatment was performed with endodontia and restoration with an amalgam filling, leading to resolution of the cutaneous sinus in 20 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cutaneous odontogenic sinuses are usually the result of pulp necrosis and chronic apical periodontitis. Patients do not typically relate these facial lesions with dental disease as associated pain is uncommon.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The lesions are often diagnosed as skin lesions, leading to the erroneous prescription of unnecessary treatments that do not resolve the problem but do delay endodontic treatment that will eliminate the dental infection and lead to closure and healing of the extraoral sinus. The diagnosis is usually made by inspection, palpation, and orthopantomography. Depending on the site of the abscess, the sinus may be intraoral or the tract may run to the skin, following the path of least resistence<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> dictated in part by muscle attachments.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> These sinuses are more commonly associated with mandibular teeth (80%) than with maxillary teeth (20%).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> They can also open into the nasal region, nasolabial folds, or at the medial canthus of the eye.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> The cutaneous opening of the sinus has an erythematous appearance and is ulcerated in the acute phase. The perilesional skin is usually slightly depressed.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> It is sometimes possible to palpate a fibrous cord that unites the site on the skin where the sinus opens with the incisor or molar that has caused the condition. Purulent material may be expressed through the cutaneous orifice when pressure is applied to the fibrous cord.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The differential diagnosis includes odontogenic cysts, foreign body reaction, salivary gland fistulas, pyogenic granuloma, tumors, and infectious diseases. Bisphosphonate-related osteonecrosis of the jaw should also be considered, particularly if there are multiple sinuses.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">No effective treatment has been established, although conservative management would appear to be the best approach. Aggressive debridement should be avoided due to the risk of subsequent recurrence and sequelae.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently, Shobatake et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> published 3 cases of cutaneous odontogenic sinuses diagnosed by ultrasound. Dermatologic ultrasound shows a well-recognized pattern with a relatively well-defined, linear but slightly tortuous, hypoechoic sinus tract that is seen to reach the surface of the cortical bone; Doppler reveals a variable degree of vascularization. Ultrasound is a tool that complements other radiologic techniques and requires little time to perform. It is an excellent option to facilitate the diagnosis of this type of lesion, even for dermatologists with little experience in the management of oral pathology. In addition, it can be used to monitor therapy and to evaluate the associated inflammation to help determine a possible indication for antibiotic prophylaxis prior to intervention.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garrido Colmenero C, Blasco Morente G, Latorre Fuentes JM, Ruiz Villaverde R. Utilidad de la ecografía doppler color para el diagnóstico de fístulas dentocutáneas. Actas Dermosifiliogr. 2015;106:678–680.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1667 "Ancho" => 1251 "Tamanyo" => 381212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous horn sunken into the skin over the left horizontal ramus of the mandible.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1216 "Ancho" => 1626 "Tamanyo" => 120332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Skin ultrasound (gray scale, longitudinal section): relatively well-defined linear but slightly tortuous hypoechoic structure that reached the surface of the cortical bone of the mandible.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1220 "Ancho" => 1628 "Tamanyo" => 144353 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Doppler study showing vascularization of the area around the tract, suggesting inflammation.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1205 "Ancho" => 1628 "Tamanyo" => 145359 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Orthopantomography showing a radiolucent image that surrounded the apex of the posterior root of the left first molar.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous sinus tracts of dental origin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 79 | 41 | 120 |
| 2024 September | 72 | 30 | 102 |
| 2024 August | 96 | 62 | 158 |
| 2024 July | 78 | 41 | 119 |
| 2024 June | 84 | 25 | 109 |
| 2024 May | 82 | 38 | 120 |
| 2024 April | 65 | 21 | 86 |
| 2024 March | 78 | 20 | 98 |
| 2024 February | 83 | 31 | 114 |
| 2024 January | 60 | 34 | 94 |
| 2023 December | 63 | 10 | 73 |
| 2023 November | 81 | 38 | 119 |
| 2023 October | 71 | 18 | 89 |
| 2023 September | 66 | 28 | 94 |
| 2023 August | 45 | 24 | 69 |
| 2023 July | 57 | 33 | 90 |
| 2023 June | 62 | 18 | 80 |
| 2023 May | 66 | 25 | 91 |
| 2023 April | 75 | 36 | 111 |
| 2023 March | 74 | 28 | 102 |
| 2023 February | 52 | 21 | 73 |
| 2023 January | 68 | 32 | 100 |
| 2022 December | 68 | 49 | 117 |
| 2022 November | 39 | 21 | 60 |
| 2022 October | 89 | 28 | 117 |
| 2022 September | 47 | 34 | 81 |
| 2022 August | 66 | 34 | 100 |
| 2022 July | 55 | 33 | 88 |
| 2022 June | 43 | 30 | 73 |
| 2022 May | 72 | 31 | 103 |
| 2022 April | 79 | 42 | 121 |
| 2022 March | 59 | 49 | 108 |
| 2022 February | 54 | 24 | 78 |
| 2022 January | 96 | 38 | 134 |
| 2021 December | 61 | 37 | 98 |
| 2021 November | 68 | 49 | 117 |
| 2021 October | 58 | 59 | 117 |
| 2021 September | 68 | 42 | 110 |
| 2021 August | 55 | 29 | 84 |
| 2021 July | 60 | 82 | 142 |
| 2021 June | 52 | 32 | 84 |
| 2021 May | 68 | 26 | 94 |
| 2021 April | 135 | 59 | 194 |
| 2021 March | 89 | 30 | 119 |
| 2021 February | 104 | 31 | 135 |
| 2021 January | 79 | 30 | 109 |
| 2020 December | 57 | 28 | 85 |
| 2020 November | 43 | 19 | 62 |
| 2020 October | 26 | 3 | 29 |
| 2020 September | 62 | 21 | 83 |
| 2020 August | 25 | 19 | 44 |
| 2020 July | 36 | 13 | 49 |
| 2020 June | 38 | 33 | 71 |
| 2020 May | 26 | 18 | 44 |
| 2020 April | 34 | 38 | 72 |
| 2020 March | 35 | 28 | 63 |
| 2020 February | 4 | 11 | 15 |
| 2020 January | 22 | 6 | 28 |
| 2019 December | 20 | 2 | 22 |
| 2019 November | 4 | 3 | 7 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 4 | 4 | 8 |
| 2019 August | 4 | 11 | 15 |
| 2019 July | 4 | 8 | 12 |
| 2019 June | 4 | 8 | 12 |
| 2019 May | 6 | 5 | 11 |
| 2019 April | 2 | 7 | 9 |
| 2019 March | 4 | 4 | 8 |
| 2019 February | 2 | 3 | 5 |
| 2019 January | 2 | 5 | 7 |
| 2018 December | 2 | 5 | 7 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 7 | 0 | 7 |
| 2018 September | 5 | 0 | 5 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 1 | 1 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 36 | 4 | 40 |
| 2018 January | 41 | 5 | 46 |
| 2017 December | 28 | 6 | 34 |
| 2017 November | 25 | 3 | 28 |
| 2017 October | 31 | 6 | 37 |
| 2017 September | 19 | 3 | 22 |
| 2017 August | 28 | 4 | 32 |
| 2017 July | 23 | 10 | 33 |
| 2017 June | 36 | 12 | 48 |
| 2017 May | 26 | 7 | 33 |
| 2017 April | 24 | 15 | 39 |
| 2017 March | 12 | 17 | 29 |
| 2017 February | 18 | 8 | 26 |
| 2017 January | 17 | 10 | 27 |
| 2016 December | 29 | 15 | 44 |
| 2016 November | 27 | 18 | 45 |
| 2016 October | 25 | 23 | 48 |
| 2016 September | 0 | 2 | 2 |
| 2016 August | 0 | 4 | 4 |
| 2016 July | 1 | 1 | 2 |
| 2016 June | 3 | 13 | 16 |
| 2016 May | 0 | 2 | 2 |
| 2016 April | 1 | 2 | 3 |
| 2016 March | 0 | 12 | 12 |
| 2016 February | 0 | 2 | 2 |
| 2016 January | 0 | 4 | 4 |
| 2015 November | 0 | 1 | 1 |
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