- 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.
- 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.
- 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)
- 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.
- 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.
- 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.
- Future protection from the sun with hats, clothing and sunscreen.
- Watch for the development of further lesions.