The phrase “hole in my cheek” describes various facial features, ranging from a common, harmless genetic trait to an acquired mark or a serious underlying medical condition. Understanding the nature of this depression—whether it is static or appears only with movement, and whether it involves drainage or inflammation—is the first step toward determining its origin. This article explores the potential biological and acquired causes for a cheek indentation. While this information can help narrow the possibilities, a physical examination by a healthcare provider remains the definitive method for accurate diagnosis and management.
Identifying Benign Facial Depressions
The most frequent and harmless cause of a natural depression in the cheek is the presence of a dimple, a structural variation in the facial musculature. This feature is often inherited as an autosomal dominant trait. The depression forms due to an anatomical anomaly in the zygomaticus major muscle, which elevates the corner of the mouth when a person smiles.
Instead of being a single, unified band, the muscle may split into a bifid or double structure. A portion of this divided muscle, typically the inferior bundle, attaches directly to the overlying dermis of the skin via connective tissue strands. When the muscle contracts during a smile, this dermal attachment pulls the skin inward, creating the characteristic transient indentation. The dimple is a dynamic feature, appearing only when the muscle is engaged, distinguishing it from a static scar.
Acquired Scars and Surface Indentations
A static depression in the cheek resembling a small hole is frequently the result of an atrophic scar. Atrophic scars develop when the skin’s natural healing process is disrupted, causing a loss of tissue volume and a sunken appearance. This occurs because the body produces too little collagen during the repair of an inflammatory lesion. Severe inflammatory acne, particularly cystic or nodular acne, is a common precursor.
Icepick Scars
The icepick scar presents as a deep, narrow, V-shaped indentation, appearing as though the skin was punctured by a sharp object. These scars are typically less than two millimeters wide and extend deep into the dermal layers. This depth makes them difficult to treat with superficial methods.
Boxcar Scars
Boxcar scars are characterized by their wider, round or oval shape with sharply defined, steep vertical walls. They resemble the appearance of chickenpox scars and are wider than icepick scars. These depressions often form on the cheeks and jaw where the skin is thicker.
Other Indentations
Indentations may also be residual marks from past facial procedures. Examples include a localized scar following the removal of a dermal piercing or a small, healed wound from localized trauma or minor surgery.
Understanding Sinus Tracts and Fistulas
A more urgent medical concern arises when the depression is an opening that actively drains fluid, indicating a sinus tract or, less commonly, a fistula. A sinus tract is an abnormal channel originating from a deeper source of infection, such as an abscess, and ending in a single opening on the skin surface. In the cheek area, these are frequently odontogenic, meaning they originate from a severe dental infection, such as a chronic periapical abscess at the root of a tooth.
The infection finds the path of least resistance through the bone and soft tissues, creating the tract to drain purulent material, or pus, onto the skin. This drainage relieves pressure from the underlying dental pathology, and the opening may periodically close and reopen. A fistula is a distinct condition, defined as an abnormal passage that connects two epithelialized surfaces, such as linking the oral cavity directly to the skin. The presence of either a tract or a fistula suggests a persistent source of deep infection, often a damaged or infected upper molar, that will not resolve without addressing the underlying cause.
When to Consult a Medical Professional
While a static indentation is usually a cosmetic issue, certain signs warrant prompt medical evaluation. The most significant warning sign is any active or persistent discharge from the site, which may be clear, cloudy, or bloody. Other indicators suggesting an ongoing inflammatory or infectious process include localized warmth, increasing redness, or swelling around the area.
If the depression is accompanied by pain, particularly a throbbing sensation, or signs of systemic illness like an unexplained fever, consultation should be immediate. A general practitioner or dermatologist can assess superficial causes like scarring. However, if a dental origin is suspected, a dentist or oral surgeon should be consulted. Diagnosing a sinus tract often requires imaging, such as a dental X-ray or CT scan, to trace the channel back to its source, often an infected tooth root.