CLINICAL CASES   

Rivista Italiana di Chirurgia Maxillo-Facciale 2002 December;13(3):183-6

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Destructive actinomycotic osteomyelitis with a double pathologic fracture of the mandible

D’Ecclesia A. ¹, Vigliaroli L. ¹, Minenna P. ²

¹ Unit of Otorhinolaryngology and Cervicofacial Pathology “Casa Sollievo della Sofferenza” IRCCS Hospital San Giovanni Rotondo (FG, Italy) 2 Unit of Dentistry and Stomatology “Casa Sollievo della Sofferenza” IRCCS Hospital San Giovanni Rotondo (FG, Italy)

Actinomycosis is an uncommon chronic granulomatous infection that causes the formation of abscesses and cutaneous fistulas. In mandibular actinomycosis, the alveolar bone and body of mandible are usually uninvolved; the pathogenic mechanism of actinomycotic proliferation is unknown. Clinical manifestations include pain at the alveolar arch and a purplish-red subcutaneous mass firmly attached to the skin areas near the angle of the mandible. Fibrous tissue produces new cutaneous suppurative fistulas. An uncommon case of actinomycotic osteomyelitis with a double pathologic fracture of the mandible is reported. Orthopanoramic X-ray and CT scan of the mandible are effective diagnostic procedures to quantify the entity and site of osteolitic areas and to define the precise position of fractures. Intravenous infusion of benzylpenicillin and daily irrigation with rifamycin were administered. Abscesses were surgically drained, with accurate curettage of the osteomyelitic lesions; several biopsies of the trabecular bone and fistulas were taken. The mandible was blocked using a resin plaque anchored to the premolars. To establish a precise diagnosis, histopathologic section and bacterioscopic culture are required. Antibiotic therapy alone is not a sufficient therapeutic approach; surgical treatment must be performed quickly, with debridement of the osteolytic lesions and retention of fractures by alveolar blockage for at least 40 days.