Moein Khojaste - Department of Periodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
Sahand Samieirad - Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
Navid Kazemian - Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
Sara Navabi - Department of Endodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

Objective: 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 ۳۴-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 ۶-month follow-up visit, the periapical lesion was healing, and the face had a normal contour.Conclusions: 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.

Cutaneous fistula, Differential diagnosis, Endodontic, Periapical Abscess, surgical treatment, Sinus tract