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Odontogenic Fistula

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1 Credit CME

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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Mar Luque-Luna, MD, Hospital Clínic de Barcelona, Spain, Dermatology Department, C/Villarroel, 170, 08036, Barcelona, Spain (mar.luqueluna@gmail.com).

Published Online: May 11, 2022. doi:10.1001/jamadermatol.2022.1245

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Kim  NG , Kim  JO , Park  YJ , Kim  JS , Lee  YJ , Lee  KS .  Cutaneous basal cell carcinoma arising in odontogenic cutaneous fistula.   Arch Craniofac Surg. 2017;18(2):141-144. doi:10.7181/acfs.2017.18.2.141PubMedGoogle ScholarCrossref
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Peermohamed  S , Barber  D , Kurwa  H .  Diagnostic challenges of cutaneous draining sinus tracts of odontogenic origin: a case report.   Dermatol Surg. 2011;37(10):1525-1527. doi:10.1111/j.1524-4725.2011.02107.xPubMedGoogle ScholarCrossref
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Cohen  PR , Eliezri  YD .  Cutaneous odontogenic sinus simulating a basal cell carcinoma: case report and literature review.   Plast Reconstr Surg. 1990;86(1):123-127. doi:10.1097/00006534-199007000-00020PubMedGoogle ScholarCrossref
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