Examination and testing ( objective ) :
a.Extraoral examination :
1. Signs of facial asymmetry
2. Palpation of the swelling to determine if it is localized or diffuse , firm or fluctuant .
3. Palpation of the cervical and mandibular LN .
4. sinus tract of odontogenic origin may open through the skin of the face ( extraoral sinus tract)
-What is the sinus and sinus tract ?
( Anatomy ) : any bodily cavity or hollow space .
( Pathology ) : an abnormal passage leading from a suppurating cavity to
the body surface : a passage leading to a cavity containing pus
[ Sinus Tract ] :
A channel leading a pathway from an enclosed area of inflammation to an epithelial surface .
opening or stoma or parulis may be intraoral or extraoral and it is an orifice through which pus is discharged .
*[ Intraoral Sinus Tract ] :
The stoma may be open in the alveolar mucosa in the attached gingival , through the furcation or gingival crevice
A sinus tract may or may not be lined with epithelium .
*[ Sinus Tract ] :
Sinus tract usually disappear spontaneously with elimination of the causative factor by root canal therapy .
b. Intraoral Examination :
intraoral sinus tract s
*Term fistula : is improperly used to describe this type of drainage
-Sinus Tract Tracing :
Sinus tracing will provide objectively in diagnosing the location of the problem
To trace a sinus tract , a size #25 gutta percha cone is threaded into the opening until resistance is felt
After a radiograph is exposed , the termination is determined by following the path taken by the GP .
-When a narrow defect is present , the DD must includes :
•The opening of a periapical endodontic lesion
•A vertical root fracture
•Present of development groove on the root surface
-Soft tissue examination :
# The gingival , mucosa , tongue and cheek should be dri…* and examined for any abnormalities in color and texture .
# Any raised lesions or ulcerations should be examined …* evaluated with biopsy or referral .
-Intraoral Swelling :
Intraoral swelling should be visualized and palpated to determine if they are diffuse , localized,
# Swelling in the anterior part of the palate is most frequently associated with infection present at the apex of maxillary lateral incisor or palatal root of maxillary first premolar
# Swelling in the posterior part of the palate is most likely associated with the palatal root of maxillary molars .
# Swelling present in the mucobuccal fold can result from infection associated with the apex of mandibular teeth that exits the alveolar bone on the facial and is superior to the muscle attachment in that area of the mandible .
# Sublingual space swelling can occur if the infection from the root apex spreads to the lingual and exits the alveolar bone superior to the attachment of mylohyoid muscle .
The tongue will be elevated and the welling will be because the sublingual space is contiguous with no midline separation .
[ Periapical testing methods ] :
Palpation test .