Introduction and importance: Sino-orbital cutaneous fistula (SOCF) directly connects the sinus, orbital space, and outer skin. SOCF has been reported mostly as a complication of orbital exenteration, although it may occur from other infrequent etiologies. The patient can be treated using an endoscopy-guided technique which requires a multidisciplinary approach. Case presentation: We present three cases of SOCF due to less common etiologies (mucocele, chronic inflammation, and malignancy) in young adult patients with a history of orbital and surgical complications. The endoscopy-guided technique benefits from a minimally invasive procedure, having less tissue removal and a faster healing time. Clinical discussion: Risk factors of developing SOCF are poor surgical technique, post-operative radiotherapy, concomitant immunocompromised state, diabetes mellitus, hypoproteinemia, or destruction caused by the tumor. The most commonly affected sinus is the frontal (60–89%). Fistula can occur with or without orbital/nasal wall destruction and bony erosion. Before starting the treatment, it is essential to make a precise diagnosis of the etiology and rule out the possibility of recurrence. SOCF can be treated with conservative or invasive management, depending on the severity of the fistula. Conclusion: It is essential to perform a thorough diagnostic examination with radiographic imaging to determine the specific cause before deciding on definitive treatment. By using the endoscopy-guided technique, long-term favorable results can be achieved. Multidisciplinary collaborative teamwork is needed to have a successful result. © 2022