Diagnosis and management of odontogenic cutaneous sinus tract: a case series

INTRODUCTION: Odontogenic cutaneous sinus tract (OCST) is an uncommon sequela of chronic endodontic infection and is frequently misdiagnosed as a dermatological lesion because dental symptoms are often minimal. CASE PRESENTATION: This case series reports four patients who presented with extraoral cutaneous sinus tracts of endodontic origin. Diagnosis was based on clinical examination, pulp sensibility testing, conventional radiography, sinus tract tracing when feasible, and cone-beam computed tomography (CBCT). CBCT is particularly useful for identifying periapical lesions, buccal cortical perforations, and tooth-related complexities when sinus tract tracing is inconclusive. Management includes nonsurgical root canal treatment/retreatment, endodontic microsurgery, and root amputation, depending on the underlying pathology. Elimination of the odontogenic source resulted in the resolution of all sinus tracts, with progressive cutaneous healing and radiographic evidence of periapical repair during follow-up, including long-term stability. CONCLUSIONS: OCST should be considered in patients with persistent facial skin lesions. Accurate identification of the causative tooth and selection of the appropriate treatment based on the underlying pathology are essential for favorable outcomes.