This document discusses sinuses, fistulas, and cysts. It defines a sinus as a blind ending tract lined by granulation tissue leading into tissues, while a fistula is an abnormal communication between two epithelium lined surfaces. Sinuses and fistulas can be congenital or acquired. Common causes of persistence include the presence of foreign bodies, necrotic tissue, epithelialization/endothelization of the tract, malignancy, and specific conditions like diabetes or tuberculosis. Clinical examination involves inspection of the site, discharge, surrounding skin as well as palpation of temperature, tenderness, induration and lymph nodes. Investigations may include blood tests, discharge cultures and smears, imaging like X-rays or MRI

1. Dr. Md. Majedul Islam
FCPS(Surgery)
Assistatnt Professor,
JIMCH
Sinus, Fistula, Cyst

2. Sinus
 Def: Blind ending tract lined by
granulation tissue leading from an
epithelial surface down into the tissues.

3. Causes
Congenital
 Preauricular sinus
 Umbilical
 Urachal
 Coccygeal
 Sacral
Acquired
 TB sinus
 Pilonidal sinus
 Median mental sinus
 Actinomycosis

4. Fistula
 Def: A fistula is an abnormal
communication between two epithelium
lined surfaces. This communication or tract
may be lined by granulation tissue

5. Types/Classification
Congenital :
 Branchial
 Tracheoesophageal
 Umbilical
Acquired :
 Fistula in ano
 Enterocutaneous fistula
 Aretriovenous fistula(Traumatic/Iatrogenic
for HD)

6.  Causes for persistence of sinus (or) fistula
1. Presence of a foreign body. e.g., suture material
2. Presence of necrotic tissue e.g.,sequestrum
3. Epithelialisation (or) endothelisation of the track.
e.g., AVF
4. Malignancy.
5. Irradiation
6. Malnutrition
7. Specific causes. e.g., DM,TB, actinomycosis
8. Ischemia
9. Drugs. e.g., steroids
10. Lack of rest
11. Insufficient (or) non-dependent drainage. e.g., TB
sinus
12. Distal obstruction. e.g., faecal (or) biliary fistula

7.  C/F: Usually asymptomatic, but when
infected manifest as-
1. Recurrent/ persistent discharge.
2. Pain.
3. Constitutional symptoms
Clinical examination:
Inspection:
 Site, number, discharge, surrounding skin
Palpation:
 Temperature, tenderness, Discharge,
 Induration, Fixity
 lymph nodes

8. Investigation:
 CB- Hb, TLC, DLC, ESR.
 Discharge for C/S , AFB, cytology,
Gram staining.
 X-RAY of the part to rule out OM,
foreign body.
 MRI (fistulogram)
 BIOPSY from edge of sinus
 Sinusogram/Fistulogram

9. Treatment principle
1. Antibiotics
2. Adequate rest
3. Adequate excision
4. Adequate drainage.