A clinical predicament--diagnosis and differential diagnosis of cutaneous facial sinus tracts of dental origin: a series of case reports.

A cutaneous draining sinus tract of dental origin is often a diagnostic challenge, because of its uncommon occurrence and absence of dental symptoms. Proper diagnosis, treatment, and the elimination of the source of infection are a must; otherwise, it can result in ineffective and inappropriate outcome of treatment. This article presents 4 cases of facial lesions misdiagnosed as being of nonodontogenic origin. The correct diagnosis in each case was cutaneous sinus tract secondary to pulpal necrosis, suppurative apical periodontitis, and osteomyelitis. In all cases, facial sinus tracts of dental origin were excised and the source of infection eliminated. The purpose of this paper is to provide diagnostic guidelines and examination protocols for differential diagnosis of cutaneous facial sinus tracts of dental origin.