Clinicopathological profile and surgical results of nonhealing sinuses and fistulous tracts of the head and neck region.

Purpose: The sinus and fistulous tracts in the head and neck region often pose a challenge to the surgeon, and are usually misdiagnosed, resulting in treatment failure.

Materials And Methods: This study included 117 patients who presented to the Department of Dental and Maxillofacial Surgery, Department of General Surgery, and Department of Dermatology of the Sheri-Kashmir Institute of Medical Sciences Medical College (Srinagar, India) over a period of 7 years. All 117 patients were analyzed using clinical methods, radiologic studies, and laboratory investigations.

Results: The mean age of patients was 30 years, with a male-to-female ratio of 3:2. A dental origin was noticed in 55% of these tracts, followed by tracts originating from infected implants or bone grafts (20%) and chronic osteomyelitis (11%). Eighty percent of these tracts had a mandibular origin (and from the anterior part) (53%). Maxillary tracts arose mostly from the posterior part of the bone (70%). The commonest presenting symptom was discharge from a nonhealing wound. Anterior mandibular tracts were straight and short (84%), whereas posterior mandibular tracts were mostly long and curved (75%). Misdiagnosed and mismanaged sinuses and fistulas were mostly of odontogenic origin (70%). Radiologic studies were the most useful diagnostic tools in tracts related to dental pathology, infected implants/bone grafts, and chronic osteomyelitis. Proper treatment of basic pathology was followed by complete healing in 96% of patients.

Conclusion: All patients with sinus or fistulous tracts in the head and neck region should be properly assessed and evaluated for proper diagnosis and treatment, to prevent the recurrence and chronicity of these lesions.