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Images in Dermatology
May 11, 2022

Odontogenic Fistula

Author Affiliations
  • 1Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
JAMA Dermatol. 2022;158(7):813. doi:10.1001/jamadermatol.2022.1245

A woman in her 90s with Alzheimer disease presented with a 4-month history of a painful, progressively growing tumor on the right cheek. Physical examination revealed an oozing, indurated 10 × 5 mm nodule (Figure). A nonmelanoma skin cancer was suspected, and excisional surgery was indicated. During the intervention, the lesion appeared to communicate with the upper alveolar mucosa as a result of being an odontogenic cutaneous fistula (OCF). Histopathological examination showed marked epithelial hyperplasia and blood vessel proliferation as well as a dense neutrophilic inflammatory infiltrate in the dermis. No cellular atypia or evidence of cancer were observed. No cultures were performed. The patient was then treated empirically with amoxicillin, 875 mg, and clavulanic acid, 125 mg, every 8 hours for 3 weeks and referred to the dentist, who removed the affected tooth, and prolonged the antibiotic therapy, completing a 5-week treatment regimen.

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