|Year : 2023 | Volume
| Issue : 1 | Page : 100-107
Management of odontogenic cutaneous sinus tract referred from dermatology and ENT clinics using cone-beam computed tomography: A case series
Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
|Date of Submission||14-Jun-2022|
|Date of Decision||28-Jul-2022|
|Date of Acceptance||03-Aug-2022|
|Date of Web Publication||11-Jan-2023|
Dr. Khalid Merdad
Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 51271
Source of Support: None, Conflict of Interest: None
An odontogenic cutaneous sinus tract (OCST) is an uncommon finding caused by prolonged periapical inflammation. Patients typically seek treatment from dermatology and ENT clinics due to a lack of intraoral symptoms and the presence of a cutaneous lesion. Misdiagnosis in certain circumstances may result in ineffective treatment. This current article describes four cases of recurrent OCST that were initially misdiagnosed and treated with surgical excision and orally administered antibiotics, without healing. These cases were referred to the endodontic clinic and diagnosed noninvasively using cone-beam computed tomography. The cases were managed by nonsurgical endodontic treatment, followed by dermatologic treatment protocol to prevent scar formation and healing was observed with a 3-year follow-up. These cases emphasize the importance of considering dental infection as a primary etiologic factor in OCST. Referral for dental care management is essential for diagnosis, treatment, and follow-up.
Keywords: Cone-beam computed tomography, cutaneous fistula, noninvasive diagnosis, odontogenic cutaneous sinus tract, odontogenic cysts
|How to cite this article:|
Merdad K. Management of odontogenic cutaneous sinus tract referred from dermatology and ENT clinics using cone-beam computed tomography: A case series. Saudi Endod J 2023;13:100-7
|How to cite this URL:|
Merdad K. Management of odontogenic cutaneous sinus tract referred from dermatology and ENT clinics using cone-beam computed tomography: A case series. Saudi Endod J [serial online] 2023 [cited 2023 Feb 3];13:100-7. Available from: https://www.saudiendodj.com/text.asp?2023/13/1/100/367510
| Introduction|| |
Endodontic treatment aims to prevent/or eliminate apical periodontitis. If microorganisms exist in the root canal system, it can cause chronic apical abscess. Infections from chronic endodontic diseases are the most general source of odontogenic cutaneous sinus tracts (OCSTs), which are uncommon and frequently misdiagnosed., This is exhibited as the abscess drains from a confined area of inflammation to the oral mucous membrane surface or skin surface of the neck and face via this tract allowing chronic suppurative material to be discharged.
Necrotic teeth are typically ignored because the offending tooth exhibits little signs following periosteum perforation. Furthermore, the sinus tract stoma may be opened at a remote site from the infection. Because most patients have no oral symptoms, the idea of odontogenic etiology is frequently disregarded. Furthermore, cutaneous lesions do not necessarily appear at the site of the underlying infection. The location of the sinus tract is determined by the location of the perforation in the cortical plate caused by the inflammatory process and its association with the muscle attachments of the face. If the tooth apices lie above the maxillary muscle attachments or below the mandibular muscle attachments, the infection will travel to the extraoral region.,
The typical method for determining the origin of OCST is an invasive procedure that includes a lacrimal probe or wire insertion., This operation has various drawbacks, as well as potential tissue damage for odontogenic or nonodontogenic tissues, patient pain, and operator stress. Due to these disadvantages, Shemesh et al., used cone-beam computed tomography (CBCT) devices as a noninvasive aid in detecting the odontogenic origin of OCST.
The rationale of this current report was to manage four cases of OCST referred by the otolaryngology and dermatology clinics to the department of endodontics at Unidents private clinic. These cases were diagnosed and managed with nonsurgical root canal treatment with 3 years follow-up using CBCT. All the four case reports were prepared according to the PRICE 2020 guidelines [Figure 1].
|Figure 1: PRICE 2020 flowchart for the management of a patient with OCST: Odontogenic cutaneous sinus tract, RCT: Randomized controlled trial, CBCT: Cone-beam computed tomography|
Click here to view
| Case Reports|| |
A 21-year-old female, in good physical condition, was referred from ENT clinic for diagnosis and treatment of a cutaneous sinus lesion in the upper right molar that had not resolved following surgical excision by an ENT surgeon. Periapical and bitewing radiographs reveal a defective occlusodistal restoration on tooth #16 [Figure 2]a and [Figure 2]b. Extraoral examination reveals an erythematous lump with a diameter of 1.1 cm on the right side of the cheek [Figure 2]c.
|Figure 2: (a) Preoperative periapical radiograph of tooth #16 (b) Preoperative bitewing radiograph for the right side. (c) Clinical photograph shows indurated and palpable mass of subcutaneous tissues in the right side of the cheek. (d) An intraoral photograph shows localized swelling in the attached mucosa in the mesial side of tooth #16. (e) An intraoral photograph (occlusal view) shows a defective restoration in the distal margin. (f) Tooth #16 has a radiolucent region in the axial, coronal, and sagittal views that advances to the buccal side and penetrates the cortical bone (arrows). (g) Clinical photograph shows the orifices of the three mesiobuccal and one distobuccal canals. (h) Intraoral photograph (occlusal view) shows the final restoration with healthy gingiva. (i) Lateral photograph shows normal skin color and complete resolution of the lesion. (j) A postoperative radiograph of tooth #16. (k) CBCT of tooth # 16 shows healed, intact buccal plate of bone and the mesio-buccal root shows 3 root canals in axial, coronal, and sagittal view (arrows). CBCT: Cone-beam computed tomography|
Click here to view
Intraoral examination revealed a palpable lump in the mesial area of tooth #16 that was attached to the gingiva and extended to the buccal mass, as well as a poor Class II composite restoration associated to the same tooth [Figure 2]d and [Figure 2]e. The tooth was sensitive to touch and percussion but did not respond to cold testing. There was no evident history of trauma or documented dental discomfort, and she had a past of several visits to her dentist with no recent follow-up.
The patient was advised to undergo CBCT imaging with a small field of view “(Carestream 9300; Carestream Health, Rochester, NY)” [Figure 2]f. A radiolucent area around the mesial and distal roots was detected on CBCT imaging, which shifted to the buccal side and invaded the cortical bone, indicating that the cutaneous mass had an odontogenic origin. The endodontic diagnosis of tooth #16 was necrotic pulp with symptomatic apical periodontitis.
Before performing the nonsurgical root canal treatment in a single session with a dental operating microscope (DOM), a consent form was signed, the tooth was anesthetized, and a rubber dam was placed. A cavity for access was made, and five canal orifices were identified. Reciproc Blue R25 instrument was used for biomechanical preparation (VDW, Munich, Germany) and irrigation with 5.25% sodium hypochlorite delivered 3 mm short of the working length with a 30 Navitip needle (Ultradent, UT). Final irrigation to remove the smear layer was carried out with 5 ml 17% EDTA followed by 5 ml of 5.25% sodium hypochlorite. Paper points were used to dry the root canals. Obturation with gutta-percha (VDW, Munich, Germany) and of bioceramics sealer (Endosequence BC, Total Fill BC) was performed by continuous wave compaction technique using System B (Sybron Endo) [Figure 2]g. Glass ionomer-based restorative materials were used to temporize the tooth (GC Fuji IX GP, GC Fuji VII, and Dyract) and sent to the prosthodontist for the final restoration. Following a consultation with a dermatologist, Fucidin cream was recommended to be used twice daily into the opening for 1 week, followed by the application of sunscreen for 6 months. Proper follow-up protocols were followed, and when the patient returned after 6 weeks, the teeth were clinically asymptomatic, and there was no discharge from the sinus tract [Figure 2]h. The sinuses had healed significantly [Figure 2]i and, at recall, the periapical lesion had clearly receded [Figure 2]j at recall visits (12, 24, and 36 months). After 36 months, a CBCT radiograph showed complete resolution of the lesion with intact lamina dura around the root apices and five canals [Figure 2]k.
A 45-year-old female was referred for evaluation and management of cutaneous sinus opening in the upper left side of the nasolabial fold that had not resolved after surgical excision by an invasive dermatologist. Periapical radiograph of tooth #23 showed prosthetic coverage and periapical radiolucency around the apex [Figure 3]a. Extraoral examination revealed an erythematous lump with crust on the left side of the nasolabial fold measuring approximately 1.5 cm in diameter [Figure 3]b.
|Figure 3: (a) A preoperative radiograph of tooth #23 with periapical radiolucency around the apex. (b) Frontal clinical photograph shows OCST in the upper left side of the nasolabial fold. (c) CBCT of tooth #23 has a radiolucent region progressing toward the buccal side and perforating the cortical bone in axial, coronal, and sagittal views (arrows). (d) A periapical scan reveals healed bone at of tooth #23. (e) Extraoral photograph shows normal skin and complete resolution of the lesion with no evidence of scar. (f) CBCT of tooth # 23 shows healed, intact buccal plate of bone in axial, coronal, and sagittal view (arrows). OCST: Odontogenic cutaneous sinus tract, CBCT: Cone-beam computed tomography|
Click here to view
An intraoral examination revealed that tooth #23 was an abutment for a three-unit bridge. The tooth was sensitive to percussion and did not respond to cold testing. There was no clear history of injury or pain linked with the teeth. The patient was referred for small field of view CBCT imaging [Figure 3]c. CBCT imaging showed a radiolucent region around the apex of tooth #23 toward the buccal side that penetrated the cortical bone, indicating that the cutaneous mass had an odontogenic origin. The endodontic diagnosis of tooth #23 was necrotic pulp with chronic apical abscess. Nonsurgical root canal treatment was completed over several appointments under magnification with DOM, a consent form was signed, during which the bridge was removed, restorability was examined, and the tooth was deemed restorable. Nonsurgical root canal procedure was followed, as reported in case 1, then an intracanal medicament, a creamy aqueous calcium hydroxide dressing, was applied and the tooth was temporized by double sealing with Cavit (ESPE, Seefeld, Germany). After 2 weeks, the tooth was opened and the same irrigation and obturation regimen as the previous case was followed by the final restoration.
After 2 weeks, the granulation area changed into smooth tissue, and the lesion was almost cured. On radiographic evaluation, the lesion had vanished, indicating successful healing [Figure 3]d. Following a 6-month follow-up and a 36-month follow-up, the defect on the cheek had faded to blend in with the surrounding tissue [Figure 3]e.
A CBCT radiograph taken 3 years later showed complete healing of the lesion, with intact lamina dura around the root apex [Figure 3]f.
A 32-year-old female was referred for examination and treatment of a cutaneous sinus cavity in the upper left side of the cheek that persisted in spite of multiple surgical excisions by an invasive dermatologist. In tooth #26, a periapical and bitewing radiographs showed a poor restoration with substandard randomized controlled trial (RCT) [Figure 4]a and [Figure 4]b. Extraoral examination revealed an approximately 2 cm diameter erythematous lump with crust on the left side of the cheek [Figure 4]c and [Figure 4]d. Intraoral examination showed a faulty Class II composite restoration on tooth #26 [Figure 4]e and [Figure 4]f. Tooth was tender to percussion with no clear history of trauma or pain.
|Figure 4: (a and b) Preapical and Bitewing radiographs show tooth #26 with substandard filling. (c and d) Extraoral photograph shows a sinus opening with discharge and depression in the buccal area of the left cheek. (e and f) Intraoral photograph lateral and occlusal views show a defective restoration. (g) Preoperative CBCT scan for tooth #26 shows radiolucent area in axial, coronal, and sagittal approaching the buccal side and piercing the cortical bone. (h and i) Extraoral clinical photographs show healed soft tissue without a scar. (j) Follow-up CBCT shows healed bone around the apices. CBCT: Cone-beam computed tomography|
Click here to view
CBCT imaging with a small field of view was performed [Figure 4]g. The cutaneous mass had an odontogenic origin, and a radiolucent area around the mesial root was detected on CBCT imaging, extending toward the buccal side and perforating the cortical bone. The endodontic diagnosis was previously treated with chronic apical abscess of tooth #26.
Nonsurgical root canal retreatment was performed under magnification with DOM in a single visit, a consent form was signed, restorability was evaluated, and the tooth was determined to be repairable. Tooth was anesthetized, and a rubber dam was placed. An access cavity was prepared, and 4 canal orifices were identified. Biomechanical preparation was performed using Reciproc Blue R25 instruments, with irrigation of 5.25% sodium hypochlorite delivered 3 mm short of the working length using a 30 Navitip needle similar irrigation and obturation protocol was performed as in the previous case followed by final restoration. The patient was reassessed 2 weeks later, and the external discharge ceased [Figure 4]h and [Figure 4]i. The sinus opening displayed obvious signs of curing. The erythematous color of the scars outside had disappeared.
Six-week, 1-year, 2-year, and 3-year recall follow-up visits were planned. The patient was asymptomatic, and clinical examination revealed significant healing of the lesion [Figure 4]j.
After 36 months, a CBCT radiograph showed complete resolution of the lesion with intact lamina dura around the root apices and 4 canals [Figure 4].
A 23-year-old female patient was referred for evaluation and treatment of an opening of the cutaneous sinus in the upper left side of the neck that did not healed in spite of surgical excision by an invasive dermatologist. A periapical radiograph of tooth #36 revealed a defective restoration and substandard RCT associated with periapical radiolucency around the apex [Figure 5]a. Extraoral examination revealed an erythematous lump with crust measuring approximately 2.5 cm in diameter on the left side of the neck [Figure 5]b.
|Figure 5: (a) A preoperative radiograph of tooth #36 with periapical radiolucency around the apex of the mesial root. (b) Frontal photograph shows OCST in the upper left side of the nasolabial fold. (c) Tooth #36 has a radiolucent region progressing toward the buccal side and penetrating the cortical bone in axial, coronal, and sagittal views (arrows). (d) A periapical radiograph reveals healed around tooth #36. (e) Extraoral photograph shows normal skin and complete resolution of the lesion with no evidence of scar. (f) Tooth #3.6 has a radiolucent region in the axial, coronal, and sagittal views that progresses to the buccal side and enters cortical bone (arrows)|
Click here to view
An intraoral examination revealed a substandard coronal restoration on tooth #36. There was a history of a previous RCT and the tooth was tender to percussion. The patient was referred for CBCT imaging with a small field of view [Figure 5]c. A radiolucent area around both apices of tooth #36 was seen on CBCT imaging, and the lesion in the mesial apex penetrating the lingual cortical bone, indicating that the cutaneous mass was odontogenic in origin. The endodontic diagnosis was previously treated with chronic apical abscess. Consent form was signed, and nonsurgical root canal retreatment was performed under magnification with DOM over multiple appointments, during which the defective restoration was removed. Tooth restorability was assessed, and the tooth was deemed restorable. Following the nonsurgical root canal procedures described in case 2, five canals were identified (3 mesial and 2 distal), a creamy aqueous calcium hydroxide dressing was used as an intracanal medicament, and the tooth was temporized by double sealing with Cavit (ESPE, Seefeld, Germany). The tooth was opened after 2 weeks, and the same irrigation and obturation as the previous case was used before the final restoration.
The sinus tract had entirely recovered after a 3-year follow-up [Figure 5]d and [Figure 5]e. A CBCT radiograph indicated that the lesion had completely healed, with intact lamina dura around the root apices and five canals [Figure 5]f.
| Discussion|| |
Long-term inflammation is frequently the cause of odontogenic sinus tracts. This inflammation spreads from the peak of a tooth contaminated with infection, or an affected area of the alveolus, and drains infectious matter through the alveolar bone, gingiva, or skin.
The findings show that periapical tissue from teeth with chronic apical abscess demonstrates a composite infectious mode of behavior in the apical section of the root canal system, The percentage of intraoral sinus tract in teeth with apical periodontitis lesions ranges from 8.5% to 18.1% while the odontogenic oral cutaneous sinus tract is uncommon condition.,, The jaws, chin, and jaw angle are the most common locations for OCST., Cutaneous lesions were linked with dental infection by Winstock, and Kaban in 1980 provided more details about the trail of increasing constant dental infections. Around 80% of cases involve mandibular teeth, while 20% include maxillary teeth. The submental region and the chin are the most commonly implicated sites, with the cheek, canine space, nostrils, and nasolabial fold being the least frequently involved. The majority of the time, the lesion is beneath the skin's surface. The lesion is a chronic periapical abscess, and the tract is granulation tissue surrounded by stratified squamous epithelium, according to histopathology. Clinically, the openings of the OCST can be boil lesion or indurated areas or combination of the two.
In general, periapical infection with OCST is not unpleasant prior to the sinus tract formation. In most situations, the affected teeth are not painful to percussion and only half of the patients are in discomfort.,, Due to a lack of intraoral sensations and an unappealing esthetic appearance, patients do not associate the cutaneous disease with dental etiology. As a result, people are more likely to seek help from medical physicians rather than dentists., It is frequently misdiagnosed and mistreated, resulting in unneeded operations and patient misery.
If the oral cutaneous sinus tract recurs, the patient should see a dentist.,,, The great majority of patients benefit from nonsurgical root canal therapy. When a patient is referred to a dental clinic with a cutaneous lesion, the source of the lesion should be determined., Tracing the sinus tract with an endodontic gutta-percha point during radiographic examination is commonly done to assist in identifying the affected tooth.,,, The disadvantage of this method includes tissue damage from both odontogenic and nonodontogenic diseases, as well as stress for the physician. CBCT images can demonstrate the odontogenic origin of extraoral lesions by revealing periapical radiolucency. In the event of extraoral lesions, cortical plate perforation leads to the lesion.
Furthermore, CBCT imaging can detect periapical radiolucency that is not seen on panoramic or periapical radiography. This makes imaging through CBCT a useful technique for diagnosis or confirming odontogenic etiology without the limitations previously discussed. If the cortical plate of the offending tooth is intact on a CBCT scan, this indicates the occurrence of a sinus tract is not of odontogenic origin. However, if the cortical plate of the problematic tooth is perforated on a CBCT scan, an intraoral or extraoral sinus tract will be shown. Whether the sinus tract is intraoral or extraoral is determined by the relationship of the root apex to the attachments of the face muscles.
The OCST may be visible, if the tooth apices are above the buccinator muscle's maxillary attachments or below the buccinator muscle, mentalis muscle's mandibular attachments, or mylohyoid muscle. As a result, the proper diagnosis in this case series is based on rigorous clinical and radiographic evaluation, including CBCT imaging scans that confirmed the cutaneous sinus tract odontogenic origin without introducing mapping measures. Infection elimination with RCT, or tooth removal if the tooth cannot be restored, is the best treatment for chronic periapical abscess with intraoral or extraoral sinus tract. In fact, following the initial therapy sessions, the sinus tracts in our cases disappeared. Calcium hydroxide is the preferred intracanal medicament because of its therapeutic effects. For the quick and effective treatment of sinus tracts caused by necrotic teeth, calcium hydroxide paste was indicated, with the sinus opening disappearing within 2 weeks of successful treatment.,, Because the lesion is a localized entity, systemic antibiotics are usually unnecessary. Systemic antibiotic therapy has been shown to produce only a brief reduction in drainage and pseudohealing., The OCST may heal with granulation tissues, but residual scarring may linger; therefore, therapy for this residual scar.
| Conclusion|| |
The cases presented here highlight the need to consider oral origin in the diagnostic process of any orofacial skin condition. If OCST exists and an oral cause is suspected, a dental examination utilizing CBCT can quickly validate the diagnosis by noninvasive to detect both the precise location of periapical radiolucency and the perforation relative to the OCST, as well as monitor the healing during follow-up. Interaction between the dentist and physician is critical for quick identification and treatment in such cases.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sjögren U, Sundqvist G. Bacteriologic evaluation of ultrasonic root canal instrumentation. Oral Surg Oral Med Oral Pathol 1987;63:366-70.
Chen K, Liang Y, Xiong H. Diagnosis and treatment of odontogenic cutaneous sinus tracts in an 11-year-old boy: A case report. Medicine (Baltimore) 2016;95:e3662.
Chouk C, Litaiem N. Oral cutaneous fistula. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC; 2022.
Baumgartner JC, Picket AB, Muller JT. Microscopic examination of oral sinus tracts and their associated periapical lesions. J Endod 1984;10:146-52.
Susic M, Krakar N, Borcic J, Macan D. Odontogenic sinus tract to the neck skin: A case report. J Dermatol 2004;31:920-2.
Tidwell E, Jenkins JD, Ellis CD, Hutson B, Cederberg RA. Cutaneous odontogenic sinus tract to the chin: A case report. Int Endod J 1997;30:352-5.
Politis C, Schoenaers J, Jacobs R, Agbaje JO. Wound healing problems in the mouth. Front Physiol 2016;7:507.
Bai J, Ji AP, Huang MW. Submental cutaneous sinus tract of mandibular second molar origin. Int Endod J 2014;47:1185-91.
Kallel I, Moussaoui E, Kharret I, Saad A, Douki N. Management of cutaneous sinus tract of odontogenic origin: Eighteen months follow-up. J Conserv Dent 2021;24:223-7.
Abuabara A, Schramm CA, Zielak JC, Baratto-Filho F. Dental infection simulating skin lesion. An Bras Dermatol 2012;87:619-21.
Laskin DM. Anatomic considerations in diagnosis and treatment of odontogenic infections. J Am Dent Assoc 1964;69:308-16.
Mittal N, Gupta P. Management of extra oral sinus cases: A clinical dilemma. J Endod 2004;30:541-7.
Gupta M, Das D, Kapur R, Sibal N. A clinical predicament-Diagnosis and differential diagnosis of cutaneous facial sinus tracts of dental origin: A series of case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e132-6.
European Society of Endodontology; Patel S, Durack C, Abella F, Roig M, Shemesh H, et al
. European Society of Endodontology position statement: The use of CBCT in endodontics. Int Endod J 2014;47:502-4.
Shemesh A, Hadad A, Azizi H, Lvovsky A, Ben Itzhak J, Solomonov M. Cone-beam computed tomography as a noninvasive assistance tool for oral cutaneous sinus tract diagnosis: A case series. J Endod 2019;45:950-6.
Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, et al
. PRICE 2020 guidelines for reporting case reports in Endodontics: A consensus-based development. Int Endod J 2020;53:619-26.
Cohenca N, Karni S, Rotstein I. Extraoral sinus tract misdiagnosed as an endodontic lesion. J Endod 2003;29:841-3.
Lubit FA, Senzer J, Rothenberg F. Extraoral fistulas of endodontic origin: Report of two cases. J Endod 1976;2:393-6.
Chan CP, Jeng JH, Chang SH, Chen CC, Lin CJ, Lin CP. Cutaneous sinus tracts of dental origin: Clinical review of 37 cases. J Formos Med Assoc 1998;97:633-7.
Pasternak-Júnior B, Teixeira CS, Silva-Sousa YT, Sousa-Neto MD. Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: Three case studies. Int Endod J 2009;42:271-6.
Bender IB, Seltzer S. The oral fistula: Its diagnosis and treatment. Oral Surg Oral Med Oral Pathol 1961;14:1367-76.
Winstock D. Four cases of external facial sinuses of dental origin. Proc R Soc Med 1959;52:749-51.
Kaban LB. Draining skin lesions of dental origin: The path of spread of chronic odontogenic infection. Plast Reconstr Surg 1980;66:711-7.
Cioffi GA, Terezhalmy GT, Parlette HL. Cutaneous draining sinus tract: An odontogenic etiology. J Am Acad Dermatol 1986;14:94-100.
Hodges TP, Cohen DA, Deck D. Odontogenic sinus tracts. Am Fam Physician 1989;40:113-6.
Spear KL, Sheridan PJ, Perry HO. Sinus tracts to the chin and jaw of dental origin. J Am Acad Dermatol 1983;8:486-92.
Cantatore JL, Klein PA, Lieblich LM. Cutaneous dental sinus tract, a common misdiagnosis: A case report and review of the literature. Cutis 2002;70:264-7.
Belmehdi A, El Harti K, El Wady W. Esthetic Improvement of a Nasolabial Cutaneous Sinus Tract. Contemp Clin Dent 2018;9:314-8.
] [Full text]
Calişkan MK, Sen BH, Ozinel MA. Treatment of extraoral sinus tracts from traumatized teeth with apical periodontitis. Endod Dent Traumatol 1995;11:115-20.
Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J 2007;40:818-30.
Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008;34:273-9.
Dincol ME, Yilmaz B, Ersev H, Mert Gunduz V, Arslanoglu B, Yalcin TY, et al
. Treatment of extraoral cutaneous sinus tracts with non-surgical endodontic intervention: Report of six cases. J Istanb Univ Fac Dent 2015;49:35-40.
Sodnom-Ish B, Eo MY, Kim SM. An accurate diagnosis of odontogenic cutaneous sinus tract by different computed tomography unit setting. J Korean Assoc Oral Maxillofac Surg 2021;47:51-6.
Allahem Z. Surgical management of a persistent periapical lesion using cone-beam computed tomography. Saudi Endod J 2021;11:271-6. [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]