医科的 に診 た外歯瘻 図1 症 例1:右 鼻翼 基 部の瘻 孔 図2 凝 血が付着 して いる 症 例1:初 耳 展 図3 症 例1:抜 歯 後4 50: 1 日 治癒 してい る 右上 犬歯 歯 肉 の発赤 腫 脹 が 見 ら れ る 図4 症 例2:初 図5 頬 部皮 膚の 浸潤 性 発 赤腫 脹 が 見 症 例2:蜂 窩 織 炎 の 所 見 を示 図6 症 例2:初 診 か ら10日 後 に瘻 孔 を形 成 す ら れ る 図8 症 例2:抜 歯 後7 治 癒 状 態 と な る 日 図9 症 例3:初 左 外 鼻 側 縁 か ら頬 部 の 腫 脹 を認 める 図10 症 例3:原 因 歯 で あ る 左 上 第1 小 臼 歯 歯 肉 に 内歯 瘻 が 見 られ る (21 ) 21
2) Marasco PV, Taylor RG, Marks MW, Argenta LC : Dentocutaneous fistula. Ann Plast Surg 29 : 205 `210, 1992. 6) Cioffi GA, Terezhalmy GT, Parlette HL : Cutaneous draining sinus tract : An odontogenic etiology. J Am Acad Dermatol 14 : 94 `100, 1986. 7) Wilson SW, Ward DJ, Burns A : Dental infections masquerading as skin lesions. Br J Plast Surg 54 : 358 `360, 2001. 8) Scot MJ Jr, Scot MJ Sr : Cutaneous odontogenic sinus. Am Acad Dermatol 2 : 521 `524, 1980. 9) Busselberg LF, Horton CE, Carraway JH : Cysts and sinuses of the face resulting from dental abscesses. Surg Gynecol Obstet 149 : 717 `718, 1979. Summary THREE CASES OF EXTERNAL DENTAL FISTULA : COURSE AND STAGES Hitoshi Enomoto, MD Enomoto Ear Nose and Throat Clinic External dental fistula is a condition where chronic suppuration of a dental root creates a fistula to the skin of the face or neck. More than 60% of patients seek consultation at a dermatology or surgical clinic because of the lack of dental disease symptoms. Some cases of external dental fistula have been mistreated with multiple incisions, repeated biopsies or prolonged treatment with antibiotics. The treatment of this condition should include extraction or other treatment of the causative tooth. Observations of three cases at different stages of diseases revealed cellulitis, abscess formation and cutaneous fistula formation after the fistula tract had penetrated the mandibular bone. The author proposes that such conditions be referred to as cellulitis of the soft tissue from external dental fistula or cellulitis from external dental fistula. Key words : external dental fistula, causative tooth, chronic apical periodontitis, extraction, odontogenic maxillary sinusitis e-mail : eno_entclinic@ybb.ne.jp