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Fistulas and sinuses for the neck and face.

What is a fistula and a breast?

A fistula is an abnormal channel that leads between two cavities or surfaces that can drain a fluid material such as saliva or pus. An example would be from the mouth (oral cavity) to the surface of the skin, usually the face or neck, and this specific type is called an orocutaneous fistula.

One sinus has an open draining end and the channel ends in a blind end. An example would be a dental drain from a dental sinus. abscess either inside the mouth or on the skin.

However, the words are often used interchangeably.

fistulas and sinuses for the neck and face: classification

Fistulas and paranasal sinuses of the neck and face can be classified by cause.


Fistulas and sinuses due to developmental causes are usually present at birth.

  • thyroglossal duct cyst – The most common development cyst in the neck. The cyst characteristically moves upwards when the tongue is stuck out or when swallowing. It may burst to form a sinus that usually opens just below the hyoid bone at the middle line from the neck Drains bugger. Treatment is surgical (Sistrunk procedure) but 10% recurs.
  • Branchial cleft cystside branchial arch cyst): the most common developmental cyst on the side of the neck. A sinus may drain mucus or pus after an abscess ruptures. It usually opens on the side of the neck, just above the junction of the clavicle and breastbone (sternoclavicular joint), in front of the sternocleidomastoid muscle. There may also be an associated sinus that drains into the pharynx.
  • Preauricular fossae and paranasal sinuses: These are common and affect the 1% population, especially Asians and blacks. 25% are bilateral in front of both ears The sinus opening (pit) is usually located just in front of the top of the ear, where the ear rim cartilage (helix) meets the facial skin. Are asymptomatic unless infected (rare), when they turn red, they hurt and may download pus.
Preauricular sinus


Preauricular sinus


Cysts are growths in the skin that contain fluctuating contents. They may have an opening in the surface of the skin.

  • Dermoid cyst
  • Epidermal cyst – formerly known as sebaceous cyst but contains curb (skin protein) no tallow (oil produced by sebaceous glands
Epidermal cyst showing opening to the outer skin


Epidermal cyst


  • Accidental
  • Radiotherapy
  • Surgical


  • Actinomycosis
  • Bone infection
    Chronic osteomyelitis – most commonly associated with poorly controlled diabetes mellitus or after radiotherapy to the jaw for Cancer or Paget's disease of bone. It can also complicate a chronic dental infection.
  • tooth infection
    • Chronic dentoalveolar abscess
    • Dental implant
    • failed endodontic procedure

Lymph node

  • Cat-scratch disease
  • tooth infection
  • Tuberculosis (scrofuloderma)





  • Oral scaly cell carcinoma is the most common

  • Benign mouth tumors rarely form a fistula

How is a fistula or sinus diagnosed?

In addition to a careful history and examination, one or more of the following tests will usually be required to confirm the diagnosis and determine the cause:

  1. passing a probe in the channel
  2. radiology: may include plain x-rays, x-rays with contrast medium, Connecticut or Magnetic resonance scans
  3. microbiological evaluation of swabs or biopsy material
  4. biopsy and pathology

Treatment of a fistula or sinus

This will be determined by the specific cause.