A primary school student had a skin fistula on his face, and the cause was actually on his teeth!

This is the 4743rd article of Da Yi Xiao Hu

A mother walked into the clinic with her child and said to the doctor, "Doctor, my child has this thing on his chin. It keeps oozing pus and won't heal. What should I do?"

(A fistula opening is seen under the patient's chin)

By asking about the medical history, we learned that this 10-year-old child accidentally fell and broke his lower front teeth a year and a half ago. The parents thought that the child's tooth did not hurt, so they ignored it. As time passed, a lump appeared on his chin. After the lump swelled up, it broke and pus oozed out. Then they began to worry and consulted many doctors, and finally came to the dentistry department. After the doctor's oral specialist examination and the imaging manifestations of the periapical film, this "chronic disease" was diagnosed as odontogenic cutaneous fistula.

(The crown of the lower left central incisor is broken and the pulp cavity is exposed)

Many times, people tend to fall into a misunderstanding, thinking that the lumps on the face come from the skin, and they will get better after a while or by taking some anti-inflammatory drugs. In the end, they find that the symptoms are not relieved, so they have to go to the hospital for treatment. If the dentist is the one who sees you, he may first consider the maxillofacial skin fistula caused by tooth infection. However, if it is a dermatologist or surgeon, he may not consider oral problems. He only treats the symptoms through local antibiotic treatment or surgical incision and drainage. However, for odontogenic skin fistula, this treatment only treats the symptoms and not the root cause, and the inflammation is prone to recurrence. This will not only delay treatment, but also affect the patient's body and mind. What exactly is this disease? It is so elusive. Let's find out.

01What is maxillofacial skin fistula?

Maxillofacial skin fistula is a skin fistula in the maxillofacial area caused by various reasons. It is often divided into odontogenic skin fistula, salivary fistula, congenital skin fistula, etc. Odontogenic skin fistula is the most common type of maxillofacial skin fistula. Without careful examination, it is easy to misdiagnose as facial furuncle.

02How do dental problems lead to maxillofacial skin fistula?

The oral and maxillofacial area is a whole. Exposed caries with bacterial invasion of the dental pulp, or pericoronitis of wisdom teeth that does not heal for a long time will lead to long-term chronic inflammation of the surrounding soft tissues and bones. As time goes by, the inflammation destroys the bones and spreads outward, and the abscess breaks outward, causing subcutaneous abscesses in places where the muscle attachment is relatively thin. Once the abscess breaks through the skin, it will form a skin fistula that does not heal for a long time. Adolescents are more likely to develop odontogenic skin fistulas because their jaws are not fully developed, their teeth are not fully developed, their apical foramina are larger, and the infection develops rapidly. Pus can easily penetrate the bone plate and skin to form skin fistulas.

03How to diagnose?

It is essential to inquire about the medical history in detail, actively find the source tooth, and carefully examine the location and direction of the fistula. If necessary, take X-rays and other imaging manifestations to assist in diagnosis.

(The periapical film shows a large area of ​​low-density shadow in the apical area of ​​the lower left central incisor)

04How to treat odontogenic cutaneous fistula?

The key to treatment is to remove the cause. For skin fistulas caused by apical periodontitis, thorough and strict root canal treatment of the affected teeth can achieve good results in most cases. Skin fistulas caused by pericoronitis and residual roots can heal on their own after the affected teeth are removed. Odontogenic skin fistulas will not heal completely if only granulation tissue resection and skin fistula scraping are performed without corresponding treatment for the causative tooth.

(The affected tooth was fully treated and the patient was re-examined half a month later, and the skin fistula was significantly improved)

Summary: Odontogenic cutaneous fistula can usually be treated with good results through appropriate oral treatment, with a high success rate and low recurrence rate. Therefore, when a maxillofacial cutaneous fistula occurs, do not ignore it or be overly nervous, and go to the dental department for treatment in time.

Author: Department of Stomatology, Affiliated Hospital of Guangdong Medical University

Zhao Yi, Peng Weida Resident Physician

Instructor: Jia Shujuan, deputy chief physician