Primary tuberculous osteomyelitis of the mandible: a case report

Abstract

A 10-year-old female child presented with a gradually increasing swelling of 2 months' duration on the left side of her face. The history given by the guardian was not very specific. However, the history revealed possible contact between the child and a tuberculous patient. The initial clinical and radiological evaluation indicated either a chronic residual dentoalveolar abscess, tuberculosis (TB) of the mandible or a malignancy. Routine laboratory investigations were grossly unremarkable with only the erythrocyte sedimentation rate being mildly raised. Further investigations were carried out, including a purified protein derivative test, chest screening, sputum examination, enzyme-linked immunosorbent assay for HIV and abdominal ultrasound, which were all negative. CT of the mandible showed a soft tissue mass in the submandibular region with an osteolytic lesion in the body of the mandible on the left side, and fine needle aspiration cytology (FNAC) showed the presence of a tuberculoid granuloma. FNAC, along with the clinical and radiographic findings and history, led to the diagnosis of primary TB of the mandible. Although FNAC is not as effective as an actual biopsy, it is often adequate for diagnosis and avoids a major surgical operation, which would be required for obtaining tissue for a biopsy. This case emphasises the role of proper history taking, diagnostic work-up and management. It also draws attention to the literature pertaining to the diagnosis of TB based on FNAC, especially in TB endemic areas where sophisticated tests such as the polymerase chain reaction are either unavailable or unaffordable.

Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma

“…4,5 TB should be considered in the differential diagnosis of chronic joint disease 4 even if routine investigations for TB are negative. 5 A study by Lanka et al 6 on the role of fine needle aspiration cytology of lymph nodes in the diagnosis of cutaneous TB states that the fine needle aspiration cytology smears in their patients with cutaneous TB with lymphadenitis were negative for AFB by the ZiehlNeelsen stain, while varying degrees of positivity are reported by others. It was concluded that an absence of AFB in smears showing an otherwise characteristic cytological picture should not weigh against the diagnosis of TB.…”

Sixty cases of extreme osteonecrosis and osteomyelitis of the mandible and maxilla in a West African population

“…It may occur through a carious tooth or in an area of gingivitis. [21][22][23] Secondary infection to the maxillofacial region can occur by haematogenous spread of the bacilli from a primary focus elsewhere in the body. 24 In the present study no information was available regarding TB status, so it cannot be excluded as a possible aetiology.…”

Primary Lingual Tuberculosis in Immunocompetent Patient: a Case Report

“…A regional extension of the soft tissue lesion may involve the underlying bone. However, involvement of the mandible by tuberculous infection is extremely rare as it contains less cancellous bone [9]. In the secondary type, oral tuberculosis coexists with the pulmonary disorder.…”