Management of extra oral sinus cases: a clinical dilemma

The cutaneous sinus tract of dental origin is an uncommon but well documented condition. Its diagnosis is not always easy unless the treating clinician considers the possibility of its dental origin. Such patients may undergo multiple surgical excisions, biopsies, and antibiotic regimens, but all of them fail with the recurrence of the sinus tract. This is because the primary etiology is incorrectly diagnosed. This case report describes the treatment of four patients presenting with variable complaints of pain and purulent or hemorrhagic discharge from lesions of the face. Clinical and radiographic examination revealed carious teeth with radiolucent areas indicating chronic periradicular abscess. The teeth were restorable, so nonsurgical endodontic therapy was performed in all of them. No systemic antibiotic therapy was provided. The patients responded well, and the cutaneous lesions healed uneventfully. Improper diagnosis can lead to needless loss of teeth that can be otherwise maintained through timely and proper management.