Three female patients ages 16, 16, and 12, and an 8-yr-old male presented with neck pathology/2 with abscesses, 1 with a submandibular mass and 1 with a spontaneously draining abscess. In 2 instances, routine oral cavity examinations including percussion of the teeth, failed to reveal significant pathology. A detailed examination by a dentist, intraoral roentgenograms, and in the first child a sinogram, identified the etiology of the lesions as periapical infections. Review of the literature reveals that these patients characteristically receive multiple surgical procedures and courses of antibiotics prior to the recognition of intra-oral disease. Extraction, or root canal, is the definitive therapy that leads to involution of the sinus tract. These four typical cases are reported to illustrate the presentation and pathogenesis of this disease entity, and the importance of an adequate dental examination prior to surgery for a draining sinus of the neck.