Introduction:
An uncommon extraoral route of infection that connects the skin and oral cavity is called a mouth cutaneous fistula (OCF). The same issue is sometimes called sinus tracts and fistulas in dentistry and medical literature. Neoplasms, salivary gland lesions, dental implant problems, trauma, and chronic infections of the teeth most frequently cause oral cutaneous fistulas. Usually, affected individuals turn to surgeons or dermatologists for assistance rather than dentists. OCF diagnosis necessitates a high level of suspicion because the disease's clinical symptoms are typically few and ambiguous. When therapy is started as soon as possible, the prognosis for odontogenic cutaneous fistulas is very good. On the other hand, problems and even death may result from oral cutaneous fistulas linked to cancers.
What Are the Causes of Odontogenic Cutaneous Fistula?
Orthogenic cutaneous fistulas cause most oral cutaneous fistula instances documented in the literature. They develop due to bacterial infiltration of the tooth pulp brought on by trauma, carious lesions, or other factors. If the damaged tooth is left untreated, the infection spreads to the periradicular region, and the pulp becomes necrotic.
Most odontogenic fistulas open intraorally, but persistent dental infections have the potential to develop into an abscess in the alveolar bone over time. The inflammatory process uses this path of least resistance as it spreads to the surrounding soft tissue and causes resorption of the periosteum and cortical bone. Above the buccinator muscle attachment in the maxilla and below the mylohyoid, mentalis, and buccinator muscle attachments in the mandible are the sites of infection dissemination.
In clinical practice, cutaneous fistulas and sinuses resulting from osteomyelitis in the craniofacial area are uncommon. Patients with uncontrolled diabetes mellitus, those who have had jaw irradiation for osteoradionecrosis, and those with metabolic bone illnesses such osteopetrosis or osteitis deformans, sometimes known as "Paget's disease," are more prone to acquire them.
Oral cutaneous fistula can also result from medication-induced osteonecrosis of the jaw. Osteonecrosis of the jaw has been documented to be induced by intravenous antiangiogenic treatments, bisphosphonates, and other anti-resorptive drugs. These drugs are used to treat conditions including osteoporosis, multiple myeloma, malignant hypercalcemia, and lytic bone metastases.
Traumatic fistulas can develop from wounds or surgical repairs. Researchers who looked at what variables lead to the development of percutaneous fistulas after head and neck reconstructive surgery discovered that patients who had received chemotherapy and radiation had a much higher chance of getting a fistula than those who had not.
Dental implant complications are often caused by an infection plus the host's inflammatory response or by the absence of it. Three months later, there was an oral cutaneous fistula connected to an osseointegrated dentoalveolar implant.
Among the rarest types of actinomycosis in the craniofacial area is periapical actinomycosis. A percutaneous fistula may develop from it. However, it is uncommon.
What Are the Symptoms Associated With Odontogenic Cutaneous Fistula?
The following are the symptoms of odontogenic fistula:
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Infections of the salivary glands can cause swelling and discomfort.
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If the parotid gland is affected, trismus may result.
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Pain and discomfort.
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If the submandibular gland is involved, then the patient may experience difficulty in swallowing.
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Fever.
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Swollen lymph node.
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Facial disfigurementation.
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Raised temperature particular to that area of infection.
How Can Odontogenic Cutaneous Fistula Be Diagnosed?
1. Clinical Presentation:
Usually, in the submental or submandibular areas, patients with odontogenic cutaneous fistulas appear with a purulent discharge and a cutaneous nodule or abscess. When they do not have oral issues, they typically consult dermatologists or surgeons instead of dentists, frequently resulting in incorrect diagnoses and delays in receiving the necessary care.
2. Radiographic:
Imaging will reveal a fistulous connection between a superficial septic focus on the skin and a persistent oral infective focus. A solid lump rather than a collection is the typical appearance of the cutaneous focus.
3. Plain Radiograph:
An orthopantomogram aids in diagnosing a persistent dental infection, which typically manifests as periapical lucency at the location of the afflicted tooth.
4. Computed Tomography (CT):
The chronic oral infective focus, the fistulous tract (with IV contrast), and the septic cutaneous nodule/collection can all be identified with CT.
5. MRI (Magnetic Resonance Imaging):
An MRI can clearly show the fistulous tract on T2 and post-contrast sequences, as well as the cutaneous lump or abscess. There will also be an abnormal signal indicating the afflicted region at the alveolar edge of the diseased tooth.
What Are the Treatment Modalities Associated With Odontogenic Cutaneous Fistula?
1. Following adequate dental treatment of the causing tooth, which may involve an extraction or endodontic therapy, the fistula resolves completely. After two weeks, the fistula usually heals by secondary intention.
2. In most cases, endodontic treatment removes the infection if the tooth can be saved. If the infection is more severe, it could be required to make a soft tissue incision and dissect it.
3. Although it often improves with time, a residual skin scar that looks dimpling or hyperpigmentation may still be present after a few months. For aesthetic purposes, the scar may require surgical care.
4. It has been found that using a negative-pressure vacuum-assisted closure method (VAC) to help close an oral cutaneous fistula (OCF) can be advantageous.
What Is the Prognosis for Odontogenic Cutaneous Fistula?
After treating the problematic tooth, odontogenic cutaneous fistulas typically cure independently without additional treatments, and they have an excellent prognosis. But to enhance the look, they frequently leave a scar that needs to be surgically controlled.
Conclusion:
An odontogenic cutaneous fistula (OCF) is an uncommon presentation of odontogenic infection that can be difficult to diagnose, although persistent periapical infection can also appear elsewhere. To treat OCF, the impacted tooth must either be extracted or undergo root canal therapy to eliminate the infection's cause.
Antibiotic treatment can temporarily close the fistula, but if the infection cause is not treated, the fistula will return. When an odontogenic cutaneous fistula is treated alone, it can resolve independently. Granulation healing usually takes five to fourteen days. The fistula and related chronic infection resolve with proper identification and treatment of an odontogenic cutaneous fistula.
