Transcript MANDIBULAR ACTINOMYCOSIS: A REPORT OF TWO CASES

L. EL ASSASSE, S. BOUTACHALI, F. AMRAOUI, T. AMIL, S. CHAOUIR, A. DARBI
Radiology service, Military hospital, Rabat, Morocco
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The mandibular actinomycosis is a rare
condition, usually secondary to tooth
extraction, mucous wound or mandibular
fracture.
We report in this work two cases of
mandibular actinomycosis explored by
orthopantomogram and facial CT and whose
diagnosis is confirmed by histology.
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These two patients aged 26 and 60 years,
both having a history as a dental extraction
with delayed mucosal healing, having
presented a mandibular pain with
perimandibular tumefaction.
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Radiological aspects were not specific with
uni or multigeodic osteolysis.
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A wide excision was indicated for them with
empiric antibiotic therapy.
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Pathological examination of surgical
specimens revealed actinomycotic osteitis.
Case 1:
Orthopantomogram showing a left pre-angular
osteolytic lesion.
Case 1:
Facial CT showing well defined multilocular osteolytic
lesion in the horizontal branch of left mandible.
Case 2:
Orthopantomogram showing a left parasymphyseal
unigeodic osteolytic lesion.
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The cervicofacial actinomycosis is a rare
infectious disease whose incidence is estimated
at 5 per 100,000 people.
It is most frequent in adults between 20 and 60
years with sex ratio 3 males to 1 female .
It is caused by germs long regarded as
intermediate between fungi and bacteria but
which proved to be true bacteria: Actinobacteria
or actinomycetes .
Involvement of the head and neck region is
the most frequent (50 to 75% of cases), thoracic
and abdominal locations are rarer.
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Contributing factors sometimes found are
poor oral hygiene, oral trauma or surgery ,
dental procedures and salivary lithiasis.
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Chronic tonsillitis, mastoiditis, and otitis are
also important risk factors for actinomycosis.
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The radiological signs of actinomycotic
osteitis are not specific.
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Involvement may be osteolytic (uni or
multigeodic) or osteoblastic.
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The
severe
forms
of
mandibular
actinomycosis can develop into the skull base
or cervical spine.
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Diagnosis is histological.
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Treatment consists of prolonged antibiotic
therapy and surgical debridement.
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Prognosis depends on early diagnosis and
treatment.
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The diagnosis of actinomycosis should be
considered in patient with recurrent and
chronic suppuration.
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The appearance on imaging is not specific
and the diagnosis of certainty is histological.
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