Diagnostic Challenges in the Detection of Actinomycotic Osteomyelitis of the Mandible: A Case Report.

Abstract

Actinomycosis is a rare chronic granulomatous infection and can be caused by Gram-positive anaerobic bacteria which are normal commensals of the oral cavity and pharynx. These organisms can involve different parts of the maxillofacial region, rarely affecting the jaws. Actinomycotic osteomyelitis is an infection of the jaw bones, typically associated with trauma or an underlying nonspecific infection or disease. Herein, we describe a rare case of actinomycotic osteomyelitis of the mandible in a healthy male patient. Comprehensive surgical treatment with curettage and peripheral ostectomy was performed. The diagnosis was made on the basis of clinical findings and the histological result. Antibiotic treatment from the penicillin group was prescribed for a period of 1 month. Diagnosis is often delayed and can be a challenge for clinical practice due to the lack of criteria other than definitive histopathological examination. A chronic clinical course without regional lymphadenopathy may be essential in the diagnosis. A number of diseases can present with similar symptoms, necessitating strict adherence to a correct surgical protocol; even when such an infection is suspected, histopathological examination is essential, and long-term treatment with penicillin is advised for accurate treatment of actinomycotic infection.