Actinomycotic Osteomyelitis of the Maxilla – A Delusive Presentation

Abstract

A 79-year-old female patient reported to the Department of Oral Medicine and Radiology, with a complaint of a progressively enlarging painless ulcer of the palate of six months duration. The ulcer caused difficulty in speech and swallowing due to nasal regurgitation. Her medical history revealed that she was a chronic diabetic patient with poor glycemic control. She was on insulin one year back and now on oral hypoglycemics. She gave a history of carcinoma breast and extensive esophageal candidiasis one year back for which she had undergone treatment. She also complained of severe headache, tiredness, nasal discharge and numbness over the right side of her face and appeared cachectic. Examination of the patient's face revealed no gross asymmetry. Intraorally, the ulcer measured approximately about 6x6cm involving most of the anterior part of hard palate with irregular and undermined edges [Table/ Fig-1]. There was exposed necrotic grey colored bone on the base of the ulcer and discrete areas of black eschar. Slough was seen more towards the periphery of the lesion. Oro-nasal communication of size approximately 1.5x1.5cm was present on the anterior part of the lesion towards right side and a smaller one towards left side. On palpation the lesion was tender. Upper deep cervical lymph nodes were palpable bilaterally. Multiple missing teeth, root stumps and caries exposed teeth were present in the maxillary and mandibular arches. Results of complete blood count and serum electrolyte analysis were within normal limits.

Actinomycotic osteomyelitis of the mandible with bone destruction: Two case reports with a review of the Japanese literatures

“…While there are reports of actinomycotic osteomyelitis being successfully treated solely with antibiotics, 2 some investigators have reported healing with concurrent surgical treatment such as scraping of the granulation tissue and removal of cortical bone. 3,11 Sixteen (57.1%) of the 28 cases were managed with surgical measures, including curettage, cortical bone removal, and tooth extraction. In both our cases, surgical treatment and antibiotic administration were performed, and no relapse was observed over 2 years after treatment.…”

Actinomycosis of maxillary antrum presenting as nasal polypi: a rare case

“…1 Actinomycosis is a suppurative and granulomatous infection presenting in three clinical forms of cervicofacial, pulmonary and abdominopelvic. 7 Cervicofacial actinomycosis is more common in males between second to fifth decades of life and accounts for more than 60% of cases. It usually affects the mandible.…”

“…Infection progresses to form an abscess which breaks down, further leading to sinus tracts and fistulas extruding yellowish drainage containing sulfur granules. 7 These granules are small pale yellow lobulated flecks of 1-5 mm, composed of gram-positive, non-acid fast mycelia with hyphae growing out towards the periphery giving a radiating appearance which gives the organism its name. Clubs may be present at the periphery composed of antigen antibody complexes.…”

Maxillary Osteomyelitis by Actinomyces in a Child

“…The exact pathophysiology of actinomycotic osteomyelitis is unclear; however it is suggested that inflammation begins when the normal composition of the microbial flora is disturbed (Meethal et al, 2016), resulting in serious infectious process that develops for over half of reported cases in the cervicofacial region. Of them only 0.5-9.0 % of the reports affect the maxillae (Esson & Lee, 2005).…”