Patient presents with apparent sinus tract in quadrant 4.  According to the patient, the sinus tract had been identified by a hygienist during a hygiene appointment.  Subsequently, the endodontic treatment had been initiated in order to resolve the infection.  Here is a clinical photo of the sinus tract-like tissue.

sinus tract

The above image shows what appears to be a non-draining sinus tract.  If this is indeed the case, it means that there should be a necrotic tooth with a lesion in close proximity to the drainage site and one should be able to express exudate from the site by poking it with a sharp explorer tip.  Upon palpation, the tissue felt like a fibrous nodule that can be easily displaced under the non-keratinized tissue and it could not be drained with an explorer.  Evaluation of available radiographs confirms lack of apical lesion in this area.  Furthermore, the radiographs show significant pulp recession and heavy coronal calcification in all teeth.  This could have resulted in false negative pulp vitality test results.

In the absence of periapical radiolucency and pain symptoms, one should not feel pressured to rush into treatment.  The diagnosis for the above tooth might have been healthy pulp with normal apical tissues which would have required no treatment.  Instead, the overall treatment has resulted in some structural compromise.

Dr. Mahmoud Ektefaie @ vanendo

0 Replies to “A Misdiagnosis: a Big Nail in This One’s Coffin”

  1. Joe says:

    hey just wanted to know why the title of this post was misdiagnosis? Was the problem not a non-draining sinus tract?

    • this was not a case of non-draining sinus tract. it was a fibrous nodule that looked like a non-draining sinus tract. palpation could confirm the finding which is different than a sinus tract. a sinus tract is also preceded by a necrotic tooth with a established lesion. none of those teeth showed a sign of apical pathosis/lesion and they all had intact pdl spaces.

  2. Joe says:

    Thanks! What is the difference in palpation between the non-draining sinus tract and a fibrous nodule? Would a non-draining sinus tract be mobile and feel firm?

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