A 17-year-old boy complained about a painful “hole” in his cheek along the jawline and an associated spontaneous purulent discharge. He was in good health and denied a history of trauma to the affected area.
Key point: This history and lesional morphology are virtually pathognomonic for a dental sinus. Radiographic examination revealed an apical dental abscess that communicated with the skin via a sinus tract, which confirmed the suspected diagnosis.
Treatment: The affected tooth was extracted and the patient given a course of oral penicillin. The sinus tract closed.
Note: The differential diagnosis includes “lump jaw” caused by Actinomycosis infection. In the former instance, examination of the purulent discharge should reveal opaque, gritty-feeling granules, and culture would likely identify the etiologic organism.