To the Editor.—
Whenever a persistent facial fistula is seen, dental causes must be considered in the differential diagnosis.1 Drainage to the surface of the chin from a focus of infection in the mandibular incisor area is uncommon. Most often the infection will drain intra-orally following the path of least resistance.2Bernick and Jensen3 recently reported a case in which a fistula of 32 years' duration was unsuccessfully treated by repeated local excision of the sinus tract. A cure was effected by endodontic therapy with apicoectomy.Such a patient may present to a physician initially for treatment. Treatment will be unsuccessful if the dental etiology is overlooked. This is most often the case when the tooth is asymptomatic. A thorough evaluation must routinely include an intra-oral examination, radiographs, and vitality tests whenever an extra-oral fistula is seen.The following case report illustrates the fact that a sinus
Rosenfeld EF, Hebda TW, Bono JA. Chronic Draining Fistula of the Chin. JAMA. 1972;222(12):1559. doi:10.1001/jama.1972.03210120053023
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