Hidden in Plain Sight: Diagnostic Challenges of Extraoral Sinus Tracts of Dental Origin: A Literature Review with Case Reports.

Extraoral cutaneous lesions of odontogenic origin are frequently misdiagnosed due to their asymptomatic dental causes and innocuous presentation. This literature review included 42 articles that highlight the diagnostic challenges of odontogenic cutaneous sinus tracts (OCSTs), which are often mistaken for skin infections, cysts, or neoplasms. As a result, patients typically consult dermatologists, general practitioners, or surgeons before reaching a dental specialist, with a diagnostic delay (Median = 12 months). Misdiagnosis can lead to unnecessary investigations, increasing patient distress and healthcare costs. IOPA radiographs with sinus-tract tracing OR cone-beam computed tomography (CBCT) are the investigation of choice to reach a correct diagnosis in such cases. A multidisciplinary approach involving timely referral to an endodontist/oral surgeon is essential for effective management. This paper presents two clinical cases from our institution that demonstrate successful diagnosis and resolution of OSCTs through appropriate dental intervention, emphasizing the importance of clinical awareness and interdisciplinary collaboration. Key Messages: Odontogenic cutaneous sinus tracts often mimic dermatologic lesions, leading to misdiagnosis. Early recognition, proper diagnosis, and timely referral to dental specialists are essential for effective management. Interdisciplinary collaboration is crucial to prevent unnecessary treatments and ensure complete healing.