Cutaneous sinus tract of dental origin

A 22-year-old male patient was referred to the department of endodontics from the department of general surgery for a dental opinion. His chief complaint was intermittent pus discharge from an opening located on the right upper cheek area of size 11×13 mm since the past 1 month (figure 1). The patient had undergone multiple excisional surgeries for the same reason. Hence, cone beam CT (CBCT) with contrast was planned for a confirmatory diagnosis. ... Images of CBCT revealed that the contrast was traversing from the external cutaneous surface up to the alveolus at the site of mesiobuccal root apex of maxillary right first molar confirming dental origin (figure 2). Thus, a diagnosis of pulpal necrosis with an extraoral cutaneous discharge was made. Root canal treatment was performed for maxillary right first molar. The follow-up at 1 year revealed successful outcome. ... Cutaneous sinus tracts of the face can be a diagnostic dilemma.1 Cutaneous dental sinus is a common and well-documented condition. The clinical differential diagnosis includes pustule, actinomycoses, osteomyelitis, oro-cutaneous fistula, neoplasms, carbuncle, infected epidermoid cyst, pyogenic granuloma, chronic tuberculosis and gumma of tertiary syphilis.2