Odontogenic cutaneous fistulae are rare and occur when chronic dental infection is complicated by a fistulous tract reaching the skin, usually in the chin or cheek regions 1.
Clinical presentation
Patients with odontogenic cutaneous fistula usually present with a cutaneous nodule or abscess, with purulent discharge, commonly in the submental or submandibular regions. They usually seek dermatological or surgical advice rather than from dentists, especially in the absence of dental problems, this commonly leads to misdiagnosis and delayed proper management 1.
Radiographic features
Imaging will identify a fistulous communication, between a chronic dental infective focus and a cutaneous superficial septic focus. The common presentation of the cutaneous focus is a solid nodule rather than a collection 2.
Plain radiograph
Orthopantomogram helps identify the chronic dental infection which usually appears as periapical lucency at the site of the affected tooth 2.
CT
CT helps in identifying the chronic dental infective focus, the fistulous tract (with IV contrast) and the septic cutaneous nodule/collection 3.
MRI
MRI can easily identify the cutaneous nodule/abscess, and delineate the fistulous tract on T2 and post-contrast sequences. Abnormal signal of the affected area in the alveolar margin of the infected tooth will be also identifiable 4.
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