Endodontic management of unusual extraoral cutaneous sinus tract

Abstract

Chronically, draining cutaneous sinus tracts are a common manifestation of pulpal necrosis with periapical pathosis that requires endodontic treatment to heal. However, it is frequently misdiagnosed with cutaneous lesions and incorrectly treated. A clinical case of an 8-year-old girl presented with an extraoral cutaneous sinus tract of the right submandibular region after long-term pus drainage was misdiagnosed by her dermatologist. The odontogenic origin of the sinus tract was made by tracing an unusual pathway of the sinus tract utilizing cone-beam computed tomography. The clinical and radiographic examination revealed a necrotic pulp, with chronic periapical abscess and cutaneous drainage of the immature mandibular right first molar. Endodontic therapy and mineral trioxide aggregate apexification were performed. The cutaneous sinus tract showed signs of healing after 1 month from treatment initiation and complete radiographic healing was noted after 18th month recall. Cutaneous extraoral sinus tracts of endodontic origin can be easily misdiagnosed and mistreated. Utilizing cone-beam computed tomography to trace the sinus tract revealed an unusual pathway confirming the odontogenic origin of the sinus tract. Correct treatment resulted in regaining the patient her self-confidence, saving the tooth, and healing of the facial sinus tract.