SavedAdd your journal

Journals / Uşak Üniversitesi Diş Hekimliği Fakültesi Dergisi / 2026 / Cilt: 4 Sayı: 2

Simultaneous Intraoral and Extraoral Sinus Tracts Associated with a Mandibular Second Molar: A Case Report

Mandibular İkinci Molar Diş ile İlişkili Eş Zamanlı İntraoral ve Ekstraoral Sinüs Yolları: Bir Olgu Sunumu

Nisa Nur Duru(INONU UNIVERSITY, FACULTY OF DENTISTRY)0009-0005-3732-1101
Neslihan Şimşek(INONU UNIVERSITY, FACULTY OF DENTISTRY)0000-0003-1142-9016
Pages
110–118
Publication Date
2026-08-19
DOI
—
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: This case highlights the importance of considering a possible odontogenic source in the differential diagnosis of persistent cutaneous sinus tracts in the head and neck region and documents a favorable clinical and radiographic outcome following nonsurgical endodontic treatment.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: The aim of this case report is to present the diagnostic process, nonsurgical endodontic treatment, and 12-month clinical and radiographic follow-up findings of a mandibular right second molar associated with simultaneous intraoral and extraoral sinus tracts.
📊
Key Findings & Data:Case Report: A 21-year-old female patient with no known chronic systemic disease was referred to the endodontics clinic for evaluation of a possible odontogenic source of infection after being hospitalized for septic shock.
💡
Conclusion & Impact:Conclusion: This case highlights the importance of considering a possible odontogenic source in the differential diagnosis of persistent cutaneous sinus tracts in the head and neck region and documents a favorable clinical and radiographic outcome following nonsurgical endodontic treatment.
🔬Design:Olgu Sunumu
📍Scope:Comprehensive Sample
⚙️Variables:Ekstraoral Sinüs Yolu · Endodontik Tedavi · İntraoral Sinüs Yolu

Abstract

Aim: The aim of this case report is to present the diagnostic process, nonsurgical endodontic treatment, and 12-month clinical and radiographic follow-up findings of a mandibular right second molar associated with simultaneous intraoral and extraoral sinus tracts. Case Report: A 21-year-old female patient with no known chronic systemic disease was referred to the endodontics clinic for evaluation of a possible odontogenic source of infection after being hospitalized for septic shock. Based on a detailed medical and dental history, clinical examination, pulp sensibility tests, periapical and panoramic radiographs, and cone-beam computed tomography findings, the pulpal diagnosis for tooth #47 was established as pulp necrosis, while the apical diagnosis was chronic apical abscess, accompanied by intraoral and extraoral sinus tract formation. Following chemomechanical preparation and intracanal medication with calcium hydroxide–chlorhexidine, root canal treatment was completed using gutta-percha and a resin-based root canal sealer. Clinical and radiographic follow-up examinations revealed marked healing of the intraoral and extraoral sinus tracts, a reduction in the size of the periapical lesion, and osseous healing. Conclusion: This case highlights the importance of considering a possible odontogenic source in the differential diagnosis of persistent cutaneous sinus tracts in the head and neck region and documents a favorable clinical and radiographic outcome following nonsurgical endodontic treatment.

Özet

Amaç: Bu olgu sunumunun amacı, eş zamanlı intraoral ve ekstraoral sinüs yolları ile ilişkili mandibular sağ ikinci molar dişin tanı sürecini, cerrahi olmayan endodontik tedavisini ve 12 aylık klinik-radyografik takip bulgularını sunmaktır. Olgu Sunumu: Bilinen kronik sistemik hastalığı bulunmayan 21 yaşında kadın hasta, septik şok nedeniyle hastaneye yatırıldıktan sonra olası odontojenik enfeksiyon odağının değerlendirilmesi amacıyla endodonti kliniğine yönlendirilmiştir. Ayrıntılı tıbbi ve dental anamnez, klinik muayene, pulpa duyarlılık testleri, periapikal ve panoramik radyografi ile konik ışınlı bilgisayarlı tomografi değerlendirmesi sonucunda; pulpa nekrozu ile ilişkili kronik apikal apse ve eşlik eden intraoral ve ekstraoral sinüs yolu oluşumu tanısı konulmuştur. Kemomekanik preparasyon ve kalsiyum hidroksit–klorheksidin ile intrakanal medikasyonu sonrası; güta-perka ile rezin esaslı kanal patı kullanılarak kök kanal tedavisi tamamlanmıştır. Klinik ve radyografik takiplerde intraoral ve ekstraoral fistül yollarında belirgin iyileşme, periapikal lezyonda küçülme ve kemik iyileşmesi saptandı. Sonuç: Bu olgu, baş-boyun bölgesindeki persistan kutanöz sinüs yollarının ayırıcı tanısında olası bir odontojenik kaynağın değerlendirilmesinin önemini vurgulamakta ve cerrahi olmayan endodontik tedavi sonrasında elde edilen olumlu klinik ve radyografik sonucu belgelemektedir.

🔖

Cite This Article

Duru, N. N., Şimşek, N. (2026). Simultaneous Intraoral and Extraoral Sinus Tracts Associated with a Mandibular Second Molar: A Case Report. Uşak Üniversitesi Diş Hekimliği Fakültesi Dergisi, Cilt: 4 Sayı: 2, 110–118. https://ajindex.com/articles/1647285

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (25)

  1. Johnson BR, Remeikis NA, Van Cura JE. Diagnosis and treatment of cutaneous facial sinus tracts of dental origin. J Am Dent Assoc. 1999;130(6):832-836. https://doi.org/10.14219/jada.archive.1999.0307
  2. Duncan HF, Kirkevang LL, Peters OA, El-Karim I, Krastl G, Del Fabbro M, et al. Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J. 2023;56(Suppl 3):238-295. https://doi.org/10.1111/iej.13974
  3. Pasternak-Junior 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(3):271-276. https://doi.org/10.1111/j.1365-2591.2008.01519.x
  4. Cantatore JL, Klein PA, Lieblich LM. Cutaneous dental sinus tract, a common misdiagnosis: a case report and review of the literature. Cutis. 2002;70(5):264-267.
  5. Jevon P, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. Br Dent J. 2020;229(6):363-370. https://doi.org/10.1038/s41415-020-2114-5
  6. Neal TW, Schlieve T. Complications of severe odontogenic infections: a review. Biology (Basel). 2022;11(12):1784. https://doi.org/10.3390/biology11121784
  7. Patel S, Brown J, Semper M, Abella F, Mannocci F. European Society of Endodontology position statement: use of cone beam computed tomography in endodontics. Int Endod J. 2019;52(12):1675-1678. https://doi.org/10.1111/iej.13187
  8. Lo Giudice R, Nicita F, Puleio F, Alibrandi A, Cervino G, Lizio AS, et al. Accuracy of periapical radiography and CBCT in endodontic evaluation. Int J Dent. 2018;2018:2514243. https://doi.org/10.1155/2018/2514243
  9. Piecha MCR, Pappen FG, Gomes FA, Sfreddo CS, Pola NM. Cone beam computed tomography vs. periapical radiograph: diagnostic accuracy in endodontic and periodontal lesions. Braz Dent J. 2026;36. https://doi.org/10.1590/0103-644020256704
  10. 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(5):619-626. https://doi.org/10.1111/iej.13285
  11. Rasimick BJ, Nekich M, Hladek MM, Musikant BL, Deutsch AS. Interaction between chlorhexidine digluconate and EDTA. J Endod. 2008;34(12):1521-1523. https://doi.org/10.1016/j.joen.2008.08.039
  12. Bashar AKM, Akter K, Chaudhary GK, Rahman A. Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata. BMJ Case Rep. 2019;12(9). https://doi.org/10.1136/bcr-2018-229039
  13. Wakhloo T, Reddy GS, Chug A. Unusual presentation of an extraoral and multiple intraoral sinus tracts in a 6-year-old pediatric patient. J Family Med Prim Care. 2020;9(8):4483-4484. https://doi.org/10.4103/jfmpc.jfmpc_754_20
  14. Sarraf P, Khoshkhounejad M, Babaahmadi M, Hamidzadeh F. An odontogenic cutaneous sinus tract in an unusual site with multiple misdiagnoses. Clin Case Rep. 2023;11(10). https://doi.org/10.1002/ccr3.8049
  15. Sung KH, Chung HW, Moon JY, Jo HH. Diagnosis and management of odontogenic cutaneous sinus tract: a case series. BMC Oral Health. 2026;26:831. https://doi.org/10.1186/s12903-026-08264-z
  16. Alibhai M, Balasundaram I, Bridle C. Cutaneous sinuses of dental origin. J Surg Case Rep. 2012;2012(8):6. https://doi.org/10.1093/jscr/2012.8.6
  17. Guevara-Gutierrez E, Riera-Leal L, Gomez-Martinez M, Amezcua-Rosas G, Chavez-Vaca CL, Tlacuilo-Parra A. Odontogenic cutaneous fistulas: clinical and epidemiologic characteristics of 75 cases. Int J Dermatol. 2015;54(1):50-55. https://doi.org/10.1111/ijd.12262
  18. Latifa H, Dorsaf T, Amira K, Karim J, Nabiha D. Surgical management of an odontogenic cutaneous sinus tract misdiagnosed for 4 years. Clin Case Rep. 2022;10(2). https://doi.org/10.1002/ccr3.5333
  19. 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(1):51-56. https://doi.org/10.5125/jkaoms.2021.47.1.51
  20. Sousa Melo SL, Fayad MI, Gohel A, Johnson BR, Kalathingal S, Mahdian M, et al. AAE and AAOMR joint position statement: use of cone-beam computed tomography in endodontics 2025 update. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026;141(1):126-135. https://doi.org/10.1016/j.oooo.2025.09.013
  21. Ozlek E, Gunduz H, Akkol E. Non-surgical endodontic treatment of extraoral sinus tract of endodontic origin. Turkiye Klinikleri J Dent Sci. 2020;26:142-146. https://doi.org/10.5336/dentalsci.2019-64897
  22. Phadke A, Patil AC, Shivanand S, Doddwad PK, Dubey R, Narvekar P. Non-surgical endodontic management of extraoral sinus using long-term placement of intracanal medicament: a case report. Int J Sci Res. 2023;12(5):569-573. https://doi.org/10.21275/SR23507183449
  23. 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(2):35-40. https://doi.org/10.17096/jiufd.73461
  24. Keerthana G, Duhan J, Sangwan P, Yadav R. Nonsurgical management of cutaneous sinus tract of odontogenic origin: a report of two cases. J Conserv Dent. 2021;24(2):219-222. https://doi.org/10.4103/jcd.jcd_125_21
  25. Hwang SW, Park HJ, Yoon DM, Park JH, Kim HY. Individualized multidisciplinary management of severe odontogenic deep neck infections with and without descending necrotizing mediastinitis: a report of two cases. J Korean Assoc Oral Maxillofac Surg. 2026;52(1):34-43. https://doi.org/10.5125/jkaoms.2026.52.1.34