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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 36  |  Issue : 1  |  Page : 18-19

Cutaneous lesion of dental origin: convenience of dermatological ultrasound diagnosis by an experienced specialist


Department of Dermatology, Leon Hospital, León, Spain

Date of Submission23-Mar-2016
Date of Acceptance03-Jul-2016
Date of Web Publication22-Nov-2016

Correspondence Address:
Paula Fernandez-Canga
C/Altos de Nava SN, 24071, León
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-6530.194157

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  Abstract 

Periapical granuloma is a common dental pathology that can progress into sinus tract formations to the skin and develop lesions that simulate primary dermatological pathology. Cutaneous lesions of this origin are rare, and differential diagnosis can be difficult as clinical appearance can be varied. A high clinical suspicion has to be supported by adequate complementary techniques. Ultrasound is an expanding, noninvasive, and reliable procedure to approach this diagnosis and has been demonstrated to be successful when practiced by cutaneous imaging experts, aiding to avoid unnecessary, aggressive diagnostic methods or erroneous surgical treatments. We report a case where ultrasonography failed and discuss the reasons for its failure.

Keywords: diagnosis, periapical granuloma, sinus tract, ultrasonography


How to cite this article:
Fernandez-Canga P, Perez-Bustillo A, Rodriguez-Prieto MA. Cutaneous lesion of dental origin: convenience of dermatological ultrasound diagnosis by an experienced specialist. Egypt J Dermatol Venerol 2016;36:18-9

How to cite this URL:
Fernandez-Canga P, Perez-Bustillo A, Rodriguez-Prieto MA. Cutaneous lesion of dental origin: convenience of dermatological ultrasound diagnosis by an experienced specialist. Egypt J Dermatol Venerol [serial online] 2016 [cited 2020 May 31];36:18-9. Available from: http://www.ejdv.eg.net/text.asp?2016/36/1/18/194157


  Introduction Top


Periapical granuloma is usually an asymptomatic lesion that arises after an irritant stimulus causes chronic inflammation at the apex of the tooth root. It may develop into a sinus tract, which can protrude as a cutaneous lesion [1] that simulates a primary dermatological pathology [2].

The exceptionality of dental etiology in orofacial skin lesions can be misleading in the diagnosis, and consequently lead to unnecessary examinations and inappropriate treatments [2],[3],[4].

In the course to accomplish the correct final diagnosis, ultrasonography has emerged as a strong technique in recent years [5], displacing orthopantomography, which was, so far, the gold standard procedure [1]. As it is an operator-dependant technique, to be profitable, ultrasonography should be performed by doctors experienced in cutaneous pathology [6].

We present a case of periapical granuloma that fistulized to the skin where ultrasound imaging was useless.


  Case report Top


We report the case of a 58-year-old woman with no personal history of interest, who presented a 5-month-old skin lesion that festered every 2 weeks.

Physical examination showed a 0.5 cm diameter normocolored papule with depressed periphery in the left mandibular region [Figure 1]. Examination of the oral cavity revealed poor hygiene but no acute infection.
Figure 1: Papule in the left mandibular region.

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Ultrasonography [Figure 2] was performed by a radiologist, describing 5.5 and 4.3 mm avascular formations in the subcutaneous tissue, without evidence of sinus tract. As a dental pathology fistulizing to the skin was the principal clinical suspicion, an orthopantomography ([Figure 3]) was performed, exposing a radiolucent lesion in the first premolar root congruous with periapical granuloma.
Figure 2: Soft tissue ultrasonography: two hypoechoic formations in the subcutaneous tissue (A=4.3mm diameter; B=5.5mm diameter).

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Figure 3: Orthopantomography: periapical radiolucent lesion at tooth 34.

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Given this finding, the maxillofacial surgery service proceeded to the extraction, curettage, and excision of the cutaneous fistula. The histopathological study objectified the existence of the sinus tract and confirmed the diagnosis of periapical granuloma.


  Discussion Top


Dental etiology should be kept in mind when evaluating a perioral skin lesion [2]. Odontogenic cutaneous fistula can show up as papules, nodules, scars, or ulcers that simulate epidermal cysts, basal-cell carcinomas, pyogenic granulomas, infections, and jaw osteonecrosis, which should be included in the differential diagnosis [1].

Ultrasonography can be a helpful technique to direct the diagnosis and discriminate between dermatological and nondermatological causes of skin lesions [7]. In lesions of dental origin, it is useful to evidence the existence of sinus tracts [5]. However, to be worthwhile, significant operator skill is required [8].

We highlight the importance of expanding the practice of ultrasound imaging among specialists in dermatology as, when performed by a trained doctor, ultasonography can be a highly effective adjuvant in the diagnosis and management of skin lesions [6],[7],[9].


  Conclusion Top


It is important to include odontomaxilar pathology in the differential diagnosis of perioral and neck skin lesions that appear to have a dermatological origin. Dermatologists ought to take advantage and boost the use of ultrasonography for diagnostic and therapeutic purposes in both general and surgical fields of dermatology as it can aid in achieving an early and accurate diagnosis, especially when performed by experienced professionals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Güleç AT, Seçkin D, Bulut S, Sarfakoğlu E. Cutaneous sinus tract of dental origin. Int J Dermatol 2001;40:650–652.  Back to cited text no. 1
    
2.
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–e136.  Back to cited text no. 2
    
3.
Herd MK, Aldridge T, Colbert SD, Brennan PA. Odontogenic skin sinus: a commonly overlooked skin presentation. J Plast Reconstr Aesthet Surg 2012;65:1729–1730.  Back to cited text no. 3
    
4.
Mittal N, Gupta P. Management of extra oral sinus cases: a clinical dilemma. J Endod 2004;30:541–547.  Back to cited text no. 4
    
5.
Garrido Colmenero C, Blasco Morente G, Latorre Fuentes JM, Ruiz Villaverde R. Diagnostic value of color Doppler ultrasound for cutaneous odontogenic sinus tract. Actas Dermosifiliogr 2015;106:678–680.  Back to cited text no. 5
    
6.
Echeverría-García B, Borbujo J, Alfageme F. The use of ultrasound imaging in dermatology. Actas Dermosifiliogr 2014;105:887–890.  Back to cited text no. 6
    
7.
Wortsman X, Wortsman J. Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2010;62:247–256.  Back to cited text no. 7
    
8.
Kleinerman R, Whang TB, Bard RL, Marmur ES. Ultrasound in dermatology: principles and applications. J Am Acad Dermatol 2012;67:478–487.  Back to cited text no. 8
    
9.
Kuwano Y, Ishizaki K, Watanabe R, Nanko H. Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol 2009;145:761–764.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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