Reconstruction of Extraoral Fistula of Dental Origin

Abstract

Odontogenic extraoral fistulas often lead to intense levels of patient discomfort and incidence of complications, which are relieved by treatment. However, the cosmetic outcome following treatment may not meet the expectations of the patient. A 51-year-old male presented with a chronically draining lesion on his left cheek. Clinical examination revealed necrosis in the mandibular left first molar and a panoramic radiograph demonstrated periapical abscess surrounding the root apex. A diagnosis of extraoral fistula of odontogenic origin was made, and the affected tooth was extracted. The extraoral fistula disappeared but the defect on the cheek exhibited no improvement over the 2 month follow-up period. Surgical revision of the defect was therefore necessary. A Limberg flap was designed and then transposed to the defect region, followed by primary closure of the donor region. The 6-month follow-up visit revealed satisfactory results for both the patient and the surgeon. This manuscript is the first case report focusing on residual defect elimination of an extraoral fistula with the use of a transpositional flap in the cheek region.