An Odontogenic Cutaneous Sinus Tract Mimicking a Mandibular Neoplasm: Diagnostic Challenges and Radiologic Correlation

Odontogenic cutaneous sinus tracts (OCSTs) are an uncommon consequence of chronic dental infection in which inflammatory drainage extends from a periapical source through bone and soft tissues to the skin surface. Although odontogenic infections typically present with intraoral symptoms such as pain, swelling, or vestibular drainage, chronic lesions may occasionally manifest as extraoral nodules, cysts, or draining sinuses. Because many patients experience little or no dental discomfort, these lesions are frequently misdiagnosed as dermatologic, infectious, or neoplastic conditions. The reported incidence of OCSTs is low, and diagnosis is often delayed because patients initially seek care from primary care physicians, dermatologists, otolaryngologists, or surgeons rather than dental providers. Common misdiagnoses include epidermoid cysts, furuncles, pyogenic granulomas, salivary gland pathology, chronic osteomyelitis, and cutaneous malignancies. Failure to identify the underlying dental etiology may result in repeated antibiotic therapy, biopsies, surgical excisions, and prolonged patient morbidity. Advanced imaging modalities, including cone beam computed tomography (CBCT) and contrast-enhanced computed tomography (CT), can provide valuable diagnostic information when conventional examination is inconclusive or when concern exists for more serious pathology. We present the case of a chronic painless mandibular mass initially investigated for possible malignancy that was ultimately diagnosed as an OCST arising from a mandibular molar with cortical perforation and extraoral extension.