Odontogenic Cutaneous Fistula: First Dermoscopic Description and a Practical Management Framework

Odontogenic cutaneous fistula (OCF) is an uncommon manifestation of dental infection that is often underrecognized because of its variable morphology and the absence of obvious dental symptoms. Misdiagnosis may lead to unnecessary tests and treatments, whereas a permanent cure depends on the elimination of the offending tooth. We report the case of a 15-year-old female who presented with progressive swelling of the right cheek and fever. Ultrasound revealed a 21.8-cc abscess, which was managed with surgical drainage and a five-day course of amoxicillin-clavulanate. Dermoscopy showed radiating white streaks surrounding the ulcer, peripheral scaling, central erosions, and serpentine vessels. These findings likely correspond to fibrosis around the fistulous tract and, to our knowledge, represent the first dermoscopic description of OCF. The patient was lost to follow-up before dental imaging could confirm the tract and identify the causative tooth. OCF presentations span a spectrum, from acute abscess-driven lesions in younger patients to chronic cases associated with osteomyelitis in the elderly, with most cases recognized in routine dermatology or dental consultations. While the majority are not abscess-associated and can be managed directly with endodontic or surgical therapy, acute cases require urgent drainage and antibiotics before definitive dental treatment. We illustrate a practical three-step framework: assessment of severity and location, stabilization of acute presentations, and elimination of the source tooth, which emphasizes anatomical location and chronicity over morphology and may improve early recognition and effective management.