Cervical necrosis and sinus tract formation secondary to a dentoalveolar infection: Report of a case

Orocutaneous sinus tracts of the head and neck region have been reported with some regularity. Diagnosis requires discrimination from local skin infection, infected dermoid cysts, carcinoma, dacryocystitis, pyogenic granuloma, mycotic infection, foreign body reaction, noma, osteomyelitis, and traumatic lesions. Those of an odontogenic nature are a special challenge because the presenting symptoms or location are not always indicative of dental infection. The patient very often does not have dental pain, and the sinus tract may not be immediately adjacent to the involved tooth. Results of cursory dental examination may be unremarkable, with the teeth appearing to be in good repair and not sensitive to percussion. Patients may have experienced intermittent remission of the symptoms, further masking the source. The following report describes a case in which the diagnosis of odontogenic infection was not made until surgical exploration of the sinus tract was done.