Cutaneous Tethering and Facial Dimpling As the Primary Manifestations of a Chronic Maxillary Odontogenic Cutaneous Sinus Tract: A Case Report and Focused Review of the Morphologic Evolution of Chronic Odontogenic Fistulas

Odontogenic cutaneous sinus tracts (OCSTs) are uncommon manifestations of chronic odontogenic infection in which inflammatory drainage extends from a periapical source through cortical bone and adjacent soft tissues before reaching the skin surface.Although these lesions are well recognized for their ability to mimic dermatologic, infectious, and neoplastic conditions, comparatively little attention has been devoted to the morphologic evolution of chronic lesions into fibrotic, tethered, and dimpled facial defects.Recognition of these subtle physical examination findings may facilitate earlier diagnosis before unnecessary medical or surgical intervention.We report the case of a 32-year-old male presenting with a painless indurated dimpled lesion involving the left cheek.Extraoral examination demonstrated localized cutaneous tethering with a small central cutaneous opening, while intraoral palpation revealed a firm ropy tract extending through the buccal vestibule adjacent to tooth #12.Periapical radiography demonstrated a chronic periapical radiolucency associated with tooth #12, and gutta-percha tracing confirmed direct communication between the cutaneous lesion and the apex of the involved tooth.The patient was diagnosed with a chronic maxillary OCST secondary to pulpal necrosis and chronic apical infection.Endodontic therapy was recommended; however, the patient was subsequently lost to follow-up before definitive treatment could be completed.This case highlights cutaneous tethering and facial dimpling as underrecognized manifestations of longstanding odontogenic infection.Awareness of these physical examination findings may improve diagnostic accuracy, facilitate earlier recognition of chronic odontogenic disease, and reduce unnecessary dermatologic and surgical procedures.