Dental Abscess With Orofacial Sinus Tract

A 59-year-old woman presents for evaluation of a painful, draining neck lesion. She is a native of India and returns to her home country yearly to visit relatives. Her teeth are in poor repair.

Key point: There is a subtle but palpable swelling at the angle of the jaw, accompanied by a hole draining purulent material. The differential diagnosis primarily consists of a dental sinus (a peri-apical dental abscess associated with a dead or dying tooth) or scrofuloderma (draining adenitits associated with Mycobacterium tuberculosis). A Quantiferon Gold test was negative for tuberculosis, as was a chest film. However, a panoramic radiograph of the jaw disclosed an abscess involving the ipsilateral last molar with loss of bone in the contiguous jaw. The abscess burrowed through soft tissues to form an orofacial sinus tract.

Treatment: The affected tooth was extracted and the patient given oral penicillin until the tract closed in 4 weeks.

Note: For healthier teeth, a root canal and endodontic treatment may be acceptable therapy.