误诊为肉芽肿的牙源性皮瘘1例

患者女,65岁。面部肿物反复溃疡流脓5个月。皮肤科情况:面部下颌处见直径为0.8 cm类圆形紫红色肿物,表面有结痂及渗出,质硬,与基底黏连,周围有红肿。初步诊断为化脓性肉芽肿,组织病理显示表皮角化过度伴角化不全,表皮突下伸增宽,真皮浅层呈急性炎症,部分为化脓性炎症伴肉芽组织形成。追问病史,面部包块出现前1个月有过牙齿肿痛不适,请口腔科会诊,可见牙龈肿胀,左下后切牙及尖、磨牙缺如。用牙胶尖从瘘口探至底部行牙齿X线检查示:瘘口至底部下颌中切牙窦道。结合临床和X线检查,诊断为牙源性皮瘘。治疗:口腔科根管治疗。

A Case of Odontogenic Fistula Misdiagnosed as Granulomatosis

A 65-year-old female suffered from tumor with recurrent ulceration and pustular secretions on the face for 5 months.Dermatological examination revealed a round purple,firm swelling mass in a diameter of 0.8 cm,with crusts and secretions,on the chin.The mass was attached to the skin and firm.A diagnosis of pyogenic granuloma was initially considered.Skin histopathology showed epidermal hyperkeratosis and parakeratosis,downward elongation of widened rete ridges,evidence of acute inflammation in the superficial dermis,and granulation tissue.Patient had had gum sore and discomfort prior to appearance of the mass on the chin.Oral examination showed swollen gums and absence of the lower left posterior incisors,sharp and molar teeth.After fully inserting gutta percha point into the fistula,dental X-ray examination showed a fistula from mandibular incisor to the chin.According to the clinical features and X ray findings,it was diagnosed as odontogenic fistula,and root canal was performed.