Cervicofacial Actinomycosis and its Management

Abstract

Cervicofacial actinomycosis is an invasive destructive infectious syndrome, caused by Gram-positive, branching filamentous bacteria, Actinomyces. Most of the cases are traced to an odontogenic source with periapical abscess and posttraumatic or surgical complications with poor hygiene and immunosuppression as contributing factors. Diagnosis is often delayed because of nonspecific and prolonged symptoms usually mimicking a malignant or a granulomatous lesion. Solitary or multiple abscesses and fistula formation across normal tissue planes accompany chronic draining lesions and may lead to invasion of viscera. Hence, early diagnosis and appropriate treatment is mandatory to reduce morbidity. In this paper, we report two cases of cervicofacial actinomycosis, one presented with intraoral granulomatous lesion treated with surgical curettage and intramuscular penicillin and another case with extraoral swelling and multiple draining sinuses treated with oral antibiotics.

Keywords: Actinomycosis; cervicofacial; granulomatous.

Figure 1

Preoperative image of the intraoral lesion

Figure 2

Computed tomography scan image showing an expansile lesion involving the left maxillary sinus

Figure 3

Two-year postoperative image with satisfactory healing and no residual defect

Figure 4

Profile picture of the patient showing diffuse swelling with multiple nodular projections

Figure 5

Axial computed tomography scan section showing soft-tissue lesion not involving the maxillary sinus

Figure 6

Coronal computed tomography section showing diffuse soft tissue involving the right infraorbital and cheek region

Figure 7

Photograph of the patient 5 months following antibiotic therapy showing regression of the swelling and the eruptions

Figure 8

Intraoral examination of the patient did not reveal any apparent traces of the lesion