Simultaneous endodontic and surgical management of skin dimpling due to an old sinus tract: a case report

Management of a skin dimpling due to a chronic periapical lesion may pose challenges. This case report presents a multidisciplinary approach to resolving a persistent cutaneous scar of endodontic origin and also offers a flowchart for the management of similar cases.

Case report: 

A 34-year-old female referred to the Endodontics Department of Mashhad Dental School at Mashhad University of Medical Sciences, complained of a skin dimpling on her face with a history of pus discharge. Diagnostic workup and radiographic examination revealed that the right mandibular first molar had a failing root canal treatment and a defective restoration. The respective tooth underwent endodontic retreatment. Due to palpation of a cord-like tract at the apical region of the tooth, surgical removal of the mentioned structure was planned using a mucoperiosteal flap. After flap elevation, the cord was cut at the base of attachment to the bone, which resulted in immediate correction of facial contour. Finally, the tooth was permanently restored. At the 6-month follow-up visit, the periapical lesion was healing, and the face had a normal contour.

Considering the significance of surgical intervention in cases with a cord-like sinus tract and consequent skin dimpling, a flowchart for a step-by-step decision-making process is offered to better restore the normal facial contour.