Uncovering Sinus Tract – Its nature, Causes and Treatment

What is a Sinus Tract?
It is an irregular type of channel or passageway that originates from the bones and draining to the skin. It can also be called a fistula. It can be concluded that it is a connection from an acute deep infection of tissue and/or bone to the surface of the skin.

How Does a Sinus Tract Occur?
When a deep infection develops such as appendicitis – a bowel infection or infection form other sources – the body tries to contain the infection and prevent it from entering the blood vessels. The collection of pus (abscess) develops in a weak area and continues to progress. When the pus accumulates, it will look for a way out of the body thus forming a narrow channel in the weak area. Eventually, the channel reaches the skin wherein it ruptures. However, since the pressure created by the abscess is relieved, the individual may or may not present with fever or other complaints.

What Are the Different Causes of Sinus Tract?
It is said that a sinus tract results from a deep infection. Uncovering Sinus Tract – Its nature, Causes and TreatmentThe following are conditions wherein the tract might develop:

  • Abdominal infections – this is a common cause of the formation of the sinus. Like for example a stitch was retained from surgery. This foreign material might lead to infection. Deep abdominal infections (appendicitis) can also cause the sinus.
  • Bone problems – chronic osteomyelitis and other infection in the long bone may develop and progress over several months. The pus accumulates from within and finds its way to the skin, forming the sinus.
  • Joint problems – a decompression or a contagion of a synovial joint in arthritis (rheumatoid) or other common rheumatism can also lead to a formation of Sinus tracts.
  • Dental problems – infection of the gums and teeth drain out of the body through intraoral sinus. According to a study, around 60% of infections originate from maxillary teeth and the remaining from mandibular teeth.
  • Ingrown hair – in the case of pilonidal cyst, ingrown hair and skin debris are deemed to cause the sinus. Excessive pressure and long periods of sitting can also cause the condition.

An infection called actinomycosis, is known to cause dental, lung, chest, abdominal and pelvic abscesses and infection. This infection develops very slowly and is often mistaken for a tumor. Months and sometimes even years pass before the pus tunnels out of the body.

Common Kinds of Sinus Tract

  • Pilonidal sinus – this is a tract that develops on the cleft or partition of the buttocks which contains hair and/or skin debris. It often affects the coccyx or tail bone but it sometimes presents in the navel, armpits or genital region. This condition sometimes develops without the person ever developing a pilonidal abscess.
    This condition was prevalent during World War II and was known as “jeep riders disease. This usually affects men and is prevalent between ages 15 to 24.
  • Pyriform sinus – presents with people afflicted with deep neck infections.
  • Intraoral sinus – cutaneous sinus tracts that drain in the face or neck may develop from dental infections, nasal dermoid cysts and other nasofrontal masses.
  • Cutaneous and neck sinus – this can result from dental infections, problems in salivary glands, neoplasms, and other developmental lesions.

What Are the Signs and Symptoms?
Since the sinus tract originates from an infection, there are several symptoms that accompany the condition. Fever can be experienced in most cases.

  • Pilonidal sinus – these tracts are usually very painful.
  • Intraoral sinus – palpable swelling is evident at the angle of the jaw, accompanied by a tunnel that drains purulent material into the skin. This comes with toothaches and other dental problems.
  • Abdominal sinus – abdominal pain due to the accumulation of pus may be felt. This is accompanied by loss of appetite and subsequent weight loss.

How to Diagnose a Sinus?
Sinus tracts are best diagnosed with the use of magnetic resonance imaging (MRI) or computed tomography (CT) scan. However, small tracts may be difficult to spot. Intravenous dye such as gadolinium may provide the needed contrast in order to find the small tunnels.

Deep abdominal infections can be diagnosed by a thorough assessment of the CT scan images. Simultaneous CT scanning can lead to better delineation of tract. Sinography with fluoroscopy is also performed to evaluate pressure sores when the extent of infection in bones is uncertain.

Telescopic hypopharyngoscopy is the definitive diagnostic method for pyriform sinus. For sinus tracts in the face and neck, dental checkups should be done to determine whether teeth, gum and other problems exist.

What is the Course Treatment?
Treatment of sinus tract will require drainage of the accumulated pus resulting from the deep infection.

  • Surgical methods – Surgery is highly recommended to remove the pus and the tract in all types of sinus tract.
    In pilonidal sinus, surgeons excise the sinus then repair the area with a reconstructive flap technique. This is used for complicated and recurring cases, and leaves minimal scar tissue. The post-surgical wound packing must be applied and replaced two times a day for a period of 4-8 weeks. However, pilonidal sinus does recur, especially when the suture is done midline.
    A new and more conservative treatment for pilonidal sinus is scraping out the tract and filling the hollow with fibrin glue. The advantage of this procedure is that it causes less pain and discomfort than the more traditional surgical treatments and allows the patient to return to his normal activities after one to two days.
    For pyriform sinus, endoscopic cauterization is highly recommended as the first choice of treatment for symptomatic patients. Complete excision should be reserved for recurrences only. Asysmptomatic patients should undergo observation before deciding on the appropriate treatment mode.
  • Pharmacologic methods – In some cases, such as that of actinomycosis, antibiotic therapy taken for prolonged periods is proven sufficient to address the problem.
    In the case of pilonidal sinus, depilatory creams can be applied on the affected area to remove the ingrown hair which causes the infection.
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