Facial fistula

ةينسلا ىودعلا تافعاضم دحأ وه يدللجا يهجولا روسانلا باهتلا اهنأ ىلع أطلخاب اهصيخشت متي ام اًبلاغ يتلاو أشنلما روسان ةلالح ريرقت مدقن. ةئطاخ ةقيرطب جلاعت يلاتلابو يدلج عم نانسلاا دحأ علخ نم تاونس ينامث دعب تثدح يهجو .اهل جلاعلا ةقيرطو ةيعاعشلاا جئاتنلاو ةيريرسلا رهاظلما Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with dermatological infection, and hence, mistreated. We report a case of facial fistula that developed 8 years following a dental extraction, presenting its clinical appearance, radiographical findings, and treatment approach. Saudi Med J 2015; Vol. 36 (4): 490-493 doi: 10.15537/smj.2015.4.11702 From the Department of Oral and Maxillofacial Surgery (Alasseri), Prince Sultan Military Medical City, and the Department of Oral and Maxillofacial Surgery and Diagnostic Sciences (Assari), Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia. Received 22nd December 2014. Accepted 4th January 2015. Address correspondence and reprint request to: Dr. Nasser A. Alasseri, Consultant, Department of Oral and Maxillofacial Surgery, Prince Sultan Military Medical City, PO Box 240771, Riyadh 11322, Kingdom of Saudi Arabia. E-mail: [email protected] that if these are not infected they can be left in the bone without any complications unless implants are considered as a treatment option.2,3 However, contaminated roots are considered a source of infection and commonly exacerbated to develop extraoral cutaneous fistula.4 These cutaneous lesions often present diagnostic challenges as the lesion may arise not in close proximity to the source of the infection, and therefore misdiagnosed and treated inappropriately.5-7 Our objective is to report a case of facial fistula that developed 8 years following a dental extraction, and to emphasize the importance of a thorough clinical examination prior to any treatment. Case Report. A 42-year-old Saudi female patient, not known to have any chronic medical illness was referred to the Department of Oral and Maxillofacial Surgery in Prince Sultan Medical Military City, Riyadh, Saudi Arabia by a consultant dermatologist with a submandibular skin fistula, that was treated by antibiotic and local creams for 3 months with no improvement. Referral was to rule out an odontogenic cause. She was seen in the Oral and Maxillofacial Clinic complaining of recurrent pus discharge from her neck for the past 6 months with no history of dental pain. Examination showed an extraoral fistula in the left submandibular region with pus discharge upon palpation, intra oral examination showed no soft tissues abnormalities in the ipsilateral area with all molar teeth missing, panoramic radiograph showed a round radiolucent lesion in the left body of the mandible with presence of radiopaque foreign body inside the lesion resembling a remaining root (Figure 1). The cone beam computed tomography evaluation showed a 1x1 cm round radiolucent lesion causing displacement of the inferior alveolar canal medially with presence of an endodontically treated root inside the lesion (Figures 2 & 3). She mentioned later that she underwent teeth extraction on the same side 8 years earlier in a private dental clinic in Taif, and Facial fistula Long-term sequelae of a complicated exodontia Nasser A. Alasseri, SBOMFS, MOMS RCPS (Glasg), Ahmad S. Assari, BDS. OPEN ACCESS T extraction is a common procedure performed in dental clinics, and is generally considered safe. As with any procedure, complications are expected to rise during or after teeth extractions, these include; infection, dry socket, hemorrhage, and dysesthesia.1 With the increasing number of surgical extractions, the frequency of complications is expected to increase. Fracture of the root tips during extraction is a frequent finding, in which sometimes the accessibility of the fractured fragment is difficult. It has been observed Case Reports 490 Saudi Med J 2015; Vol. 36 (4) www.smj.org.sa 491 www.smj.org.sa Saudi Med J 2015; Vol. 36 (4) Facial fistula due to complex exodontia ... Alasseri & Assari was not informed of any intraoperative complications. Following patient consent and under general anesthesia a lateral cortical window was reflected through an intraoral approach; the remaining root was exposed then removed, and the surrounding infected tissue was excised completely with preservation of the inferior alveolar nerve that was dissected and preserved medially. The cortical window was fixed to the original place by a microplate (1.5 mm) to enhance the stabilisation of the bony segment (Figures 4 & 5). The fistula was traced and excised completely with elliptical excision and closed primarily (Figure 6). Postoperatively, she was cleared from the infection but had temporary hypoesthesia in the left cheek area, which fully recovered 3 weeks after surgery. No further complications were reported. Figure 1 Orthopantomogram showing the remaining root of the tooth extracted 8 years earlier and the fistula (arrow). Figure 2 Preoperative CT view showing: A) axial view, and B) curved view of the remaining root of the tooth extracted 8 years ago (arrows). Figure 3 Preoperative coronal view of the remaining root of the tooth extracted 8 years ago (arrow). Figure 4 Orthopantomogram post removal of remaining root and fixation of the cortical window (immediate postop) (arrow).