title: Submental cutaneous sinus tract as a result of progressive peri-implantitis: a case report.
abstract: BACKGROUND
  The aim of the present case report was to define diagnosis and treatment options of a submental cutaneous sinus tract as a result of a progressive peri-implantitis around mandibular dental implants in a patient with a history of oral squamous cell carcinoma.
  
  
  METHODS
  Before the removal of the submental fistula, a panoramic radiograph and a computed tomography of the head and neck were assessed to identify the implants responsible for the cutaneous sinus tract and to exclude the presence of a tumor recurrence and lymph node metastases. The involved implants were removed, as there was a communication along them between the oral cavity and the cutaneous sinus tract resulting from progressive peri-implantitis. A histological examination of the excised fistula was carried out.
  
  
  RESULTS
  The histological examination excluded a recurrence of the oral squamous cell carcinoma. The fistula completely consisted of granulation tissue without epithelialization. After affected implants were removed, the wound healing was uneventful.
  
  
  CONCLUSIONS
  A panoramic radiograph is mandatory to identify the involved implants. Computed tomography, and excision of the fistula and a histological examination should be performed only in patients with a history of oral squamous cell carcinoma. Since the cutaneous sinus tract showed no epithelialization, it healed spontaneously after the removal of the responsible implants. Because of the large bony defect caused by progressive peri-implantitis leading to a communication of the oral cavity with the cutaneous sinus tract, more conservative treatment options with preservation of the implants could not be adopted in the present case.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. emeka.nkenke@mkg.imed.uni-erlangen.de
authors.forename: Emeka
authors.initials: E
authors.lastname: Nkenke
authors.forename: Kerstin
authors.initials: K
authors.lastname: Amann
authors.forename: Sven
authors.initials: S
authors.lastname: Reich
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Neukam
authors.forename: Roland
authors.initials: R
authors.lastname: Frankenberger
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D015921:Dental Implants / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D016155:Oral Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D010518:Periodontitis / Q000150:complications*; D011862:Radiography, Panoramic; D014057:Tomography, X-Ray Computed; D014945:Wound Healing
chemical_list: D015921:Dental Implants