Dental Sinus

Aetiology

• Sinus track that drains on to the face or neck from a dental infection.
• More commonly associated with mandibular teeth, less often the maxillary teeth.

Presentation

• Pimple, nodule, ulcer or indurated cystic area.
• Drainage usually occurs on the submandibular, submental regions to the chin or sometimes the cheek or naso-labial fold.
• Often no problems of toothache.
• Affected tooth may be tender on percussion.
• Sinus track may drain onto the face but more usually into the mouth.
• Dental problem may have occurred years earlier and been forgotten by the patient.

Management

• Dental X-ray to identify the source of the problem.
• Extraction of the tooth should quickly lead to resolution of the sinus.
• Antibiotics if the patient is ill with fever or has lymphadenopathy.

Basal Cell Carcinoma (BCC)

Aetiology

• Common in the fair skinned, on sun-exposed skin or following exposure to X-rays or arsenic.
• More common in the elderly, but may affect sun worshippers at a younger age.
• Genetic factors e.g. Gorlin syndrome.

Presentation

• BCCs may be nodular, superficial with slowly growing irregular pink scaly plaques, pigmented or morphoeic with sclerosis that may resemble a waxy scar.
• Telangiectasia may run across the lesion.
• Lesion may ulcerate.
• If stretched a raised, rolled, pearly ring may be obvious.

Management

• Treatment depends on size and site of the lesion(s).
• Good prognosis if adequately treated.
• Shave, curettage and cautery may be sufficient for small lesions.
• Biopsy to confirm diagnosis or excision and histology.
• Imiquimod three to five times a week for six to 16 weeks.
• Radiotherapy.
• Future protection from the sun with hats, clothing and sunscreen.
• Watch for the development of further lesions.