At a Glance - Dental sinus versus basal cell carcinoma

Contributed by Dr Jean Watkins, a sessional GP in Hampshire

Dental Sinus
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)
Basal cell carcinoma lesions may ulcerate

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.

 

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus