Cervicofacial Actinomycosis And Its Management
Question. Discuss in detail Cervicofacial Actinomycosis.
Answer. Actinomycosis is a chronic granulomatous, suppurative, and fibrous type of disease caused by anaerobic gram-positive, non-acid-fast bacteria.
The most common microorganisms are Actinomyces israelii, A. actinomycetemcomitans, A. viscosus, and A. odontolyticus.
Cervicofacial Actinomycosis symptoms
Cervicofacial Actinomycosis Predisposing Factors
- Trauma: Break in the continuity of mucosa due to trauma or surgery.
- Local factors: Infections leading to cervicofacial actinomycosis are endogenous in origin and occur when dental plaque, calculus, or the gingival debris contaminates deep wounds around the mouth. A carious tooth can also cause cervicofacial actinomycosis.
- Others: Hypersensitivity reaction and secondary bacterial invasion may act as predisposing factors.
Cervicofacial Actinomycosis Clinical Features
- It is the most common type of actinomycosis and is seen in adult males.
- The submandibular region is the most frequent site of infection.
- Trismus is the most common feature before the formation of pus.
- The first sign of infection is characterized by the formation of a palpable mass. Mass is painless and indurated.
- There may be associated changes detectable at the portal of entry, such as a non-healing tooth socket, exuberant granulation tissue, or periosteal thickening of the alveolus.
- The development of a fistula is common. Skin surrounding the fistula is purplish. Consistency of adjacent tissues is doughy.
- Sulphur granules: Hard, circumscribed tumor-like swellings may develop and undergo breakdown, discharging yellow fluid containing submicroscopic sulfur granules.
Cervicofacial Actinomycosis Oral Manifestations
- It produces swelling and induration of tissue.
- It may develop into one or more abscesses, which tend to discharge onto the skin surface, liberating pus, which contains typical sulphur granules.
- There may be a non-healing tooth socket, exuberant granular tissue, and periosteal thickening of the lveolus.
- It is common for sinus, via which abscess is drained, to heal, but due to chronicity, new abscesses are formed and perforate through the skin surface.
- Disfigurement of the face is present as infections involve the maxilla and mandible.
- On the one hand, a lesion is a painful nodule that eventually ulcerates. In untreated cases tongue may be fixed.
Radiographic findings in Actinomycosis
Cervicofacial Actinomycosis Radiographic Features
- Radiographic appearance resembles apical rarefying osteitis. Scattered areas of bone destruction are separated from one another by normal or sclerosed bone.
- It appears as an area of bone destruction, which resembles a dental cyst, with a well-defined area of radiolucency with a cortical lining of dense bone.
- Lamina dura is deficient at the apex of a tooth.
- Persistent radiolucency of the tooth socket with increased density of adjacent bone can be the first sign of disease.
Cervicofacial Actinomycosis Diagnosis
- Clinical diagnosis: Sulfur granules with the formation of a fistula and sinus, along with fever, provide a clue to the diagnosis.
- Radiological diagnosis: Scattered areas of bone destruction which are separated from one another by normal or sclerosed bone.
- Laboratory diagnosis: On examination, there is the presence of a round or lobulated colony meshwork of filaments, stained by hematoxylin, and peripheral club ends of filaments, stained by eosin, showing a typical ray fungus appearance, which is characteristic.
Granulomatous oral lesions
Cervicofacial Actinomycosis ManagementTwo-foldd therapy is given, i.e., including antibiotics and surgery.
- The lesion is surgically removed, and thorough debridement is required.
- Penicillin should be given, i.e,. 3 to 4 million IV, 4 hours toll 2 to 4 weeks.
- This should be followed by 0.5 to 12 g of penicillin, four times a day for a period of 4 to 6 weeks.
- If the patient is allergic to penicillin, tetracycline orally 500 mg QDS for 6 months.
Leave a Reply