Case report of an extra-oral cutaneous sinus tract of endodontic origin in a patient with autism spectrum disorder

Abstract

Background and Overview: Extraoral cutaneous sinus tracts (EOCST) are often misdiagnosed due to their unexpected appearance without history of odontogenic pain, discomfort, or cellulitis. Diagnosis can be further confounded in those with sensory processing difficulties since patients can have a hypersensitivity to sensory input, but simultaneously demonstrate hyposensitivity and indifference toward pain. EOCST misdiagnosis and resultant mismanagement can lead to multiple surgical excisions, biopsies, and elongated antibiotic regimens, with eventual lesion recurrence. Case Description: A 19-year-old white male with autism spectrum disorder in the period of transitional dental care presented with a history of a chronic EOCST. The patient required sedation for evaluation, biopsy, and was initially managed by infectious disease under the impression of an actinomycosis infection. The patient completed a twelve-month course of antibiotic therapy with subsequent lesion re-occurrence. Eventually, the diagnosis of an EOCST of dental origin was confirmed. It was determined that pulpal necrosis was due to localized dental trauma of the lower left central incisor, as a result of a self-injurious behavior. Root canal treatment eventually led to the resolution of the lesion. It took three years from initial clinical presentation for the resolution of the lesion. Conclusions and Practical Implications: Collaboration between the medical and dental healthcare team in diagnosis and treatment planning for a patient with special needs is essential to ensure prompt and appropriate care for this patient group.