Role of CBCT and non-surgical endodontic management of misdiagnosed odontogenic extraoral sinus tracts: Three case reports

Abstract

Odontogenic extraoral sinus tracts are uncommon clinical conditions that frequently present diagnostic challenges because of their atypical extraoral appearance and the frequent absence of dental symptoms. Consequently, these lesions are often misdiagnosed as dermatologic or systemic diseases, resulting in inappropriate treatments, prolonged morbidity, and delayed healing. Accurate identification of the odontogenic source is essential for definitive management. These case reports describe three female patients who presented with persistent extraoral sinus tracts of odontogenic origin that had been previously misdiagnosed and managed as dermatologic lesions. All patients had undergone prolonged topical or conservative treatments without clinical improvement. Comprehensive clinical examination and conventional radiography, supplemented by cone-beam computed tomography (CBCT), revealed necrotic pulps associated with periapical lesions, accessory root canals, and localized bone defects in the affected teeth. All cases were treated using a non-surgical endodontic approach. CBCT played a critical role in detecting complex root canal anatomy and guiding treatment planning. Root canal disinfection protocols included irrigation with sodium hypochlorite and ethylenediaminetetraacetic acid, ultrasonic activation, and the use of calcium hydroxide as an intracanal medicament, between appointments. Final obturation was performed using gutta-percha and a bioceramic sealer, followed by definitive coronal restoration. Clinical follow-up demonstrated progressive resolution and complete closure of the extraoral sinus tracts in all patients. At the one-year follow-up, complete soft tissue healing and radiographic evidence of periapical bone regeneration were observed, with no signs of recurrence. All treated teeth remained asymptomatic and functional during the follow-up period. These cases emphasize the importance of including odontogenic origins in the differential diagnosis of persistent extraoral facial lesions. CBCT is a valuable diagnostic adjunct in complex cases, particularly for identifying accessory canals and periapical pathologies. When accurately diagnosed, non-surgical endodontic treatment provides a predictable, minimally invasive alternative to surgical intervention, enabling complete functional and esthetic healing while preventing unnecessary dermatologic or surgical procedures.