Quiste radicular residual / A residual radicular cyst

En la región cervicofacial los quistes de los maxilares de origen odontogénico constituyen una afección relativamente importante, los más frecuentes son los quistes radiculares. Se presentó un paciente masculino de 23 años de edad con un quiste radicular residual extenso que ocupaba la zona mandibular posterior izquierda, y acude a consulta estomatológica de la Clínica «Celia Sánchez Manduley» por un aumento de volumen que causa asimetría facial notable de la hemicara izquierda, de tres centímetros de diámetro, indoloro, asintomático, con 6 meses de evolución y consistencia dura; además refiere tratamiento de exodoncia de molar inferior en la zona (37) hace 2 años. Se indicó radiografía periapical y panorámica donde se observó zona radiolúcida bien definida de 35 a 38 con reabsorción de raíz mesial de 38, distal de 36 y movilidad dentaria grado II en ambos dientes. Se realizó exéresis de la lesión cuyo estudio histológico informó un quiste radicular residual.

Jaw cysts of odontogenic origin constitute a relatively important condition in the cervicofacial region, where radicular cysts are the most frequent. We present a 23-year-old male patient who come to "Celia Sánchez Manduley" Dental Clinic with an extensive residual radicular cyst that occupied his left posterior mandibular area and an increase in volume that caused him a notable facial asymmetry in the left side of his face, of three centimeters in diameter, painless, asymptomatic, with 6 months of evolution and hard consistency; he also mentions a lower molar extraction treatment in area (37) 2 years ago. Periapical and panoramic X-rays were indicated where a well-defined radiolucent zone of 35 to 38 was observed with mesial root resorption of 38, distal of 36 and grade II dental mobility in both teeth. Exeresis of the lesion was performed, whose histological study reported a residual radicular cyst.

Aspectos clínico-epidemiológicos en pacientes con abscesos odontogénicos cervicofaciales y factores asociados para estancia hospitalaria corta / Clinical-epidemiological aspects in patients with cervicofacial odontogenic abscesses and associated factors for short hospital stay

Introducción: en todo paciente hospitalizado con absceso odontogénico cervicofacial se busca resolución pronta del absceso, pero es necesario conocer cuáles son los factores que favorecen la resolución en hospitalizaciones cortas (1-3 días). Objetivo: determinar factores clínico-epidemiológicos de pacientes con abscesos odontogénicos para identificar factores que correlacionan con hospitalización corta. Material y métodos: estudio transversal, retrospectivo, observacional y analítico de 100 pacientes con abscesos odontogénicos en un Hospital General de Zona del Instituto Mexicano del Seguro Social de los años 2012-2013. Variables de estudio: días de hospitalización, sexo, edad, comorbilidades, conteo leucocitario, trismus, diente causal, región afectada y tratamientos realizados. Tamaño de muestra obtenido con fórmula para estudios observaciones con manejo de prevalencias para poblaciones infinitas, se empleó χ2 para identificar factores que correlacionan con hospitalización corta. Resultados: mujeres 56%, rango de edad 12-89 años y de hospitalización de 1-23 días; con comorbilidades 56%, leucocitosis 39% y trismus 21%. La caries causó 64% de abscesos, molares inferiores 70% y región submandibular afectada 73%. Variables estadísticamente significativas; conteo leucocitario, diente causal y región afectada. Conclusión: factores correlacionados con hospitalización corta: conteo leucocitario menor a 10,500 leucocitos, que el molar inferior no sea el diente causal y que la región submandibular no esté afectada (AU)

Introduction: prompt resolution of the abscess is sought in all patients hospitalized with cervicofacial odontogenic abscess, but which factors favor this resolution in short hospitalizations (1-3 days). Objective: determine clinical-epidemiological factors of patients with odontogenic abscesses to identify factors that correlate with short hospitalization. Material and methods: crosssectional, retrospective, observational and analytical study of 100 patients with odontogenic abscesses in a General Hospital of the Zone of the Mexican Social Security Institute from 2012-2013. Study variables; days of hospitalization, sex, age, comorbidities, leukocyte count, trismus, causative tooth, affected region and treatments performed. Sample size obtained with the formula for observational studies with prevalence management for infinite populations, χ2 was used to identify factors that correlate with short hospitalization. Results: women 56%, age range 12-89 years and hospitalization of 1-23 days, with comorbidities 56%, leukocytosis 39% and trismus 21%. Caries caused 64% of abscesses, lower molars 70% and affected submandibular region 73%. Statistically significant variables; leukocyte count, causative tooth and affected region. Conclusion: factors correlated with short hospitalization; leukocyte count less than 10,500 leukocytes, that the lower molar is not the causal tooth and that the submandibular region is not affected.

Infección posoperatoria por Actinomicosis israelí / Postoperative Israeli Actinomycosis Infection

La actinomicosis es una enfermedad supurativa crónica causada por Actinomyces israelii, este es un saprófito de la cavidad oral, criptas amígdalinas y el tracto gastrointestinal en un 30% de sujetos sanos. Es una enfermedad poco frecuente con una incidencia de 5/100 000. La mayoría de las veces se presenta como una complicación por el uso de bifosfona-tos o inmunosupresión como malignidad o diabetes mellitus y, raramente, por procedi-mientos orales.

Actinomycosis is a chronic suppurative disease caused by Actinomyces israelii, this is a saprophyte of the oral cavity, amygdaline crypts and the gastrointestinal tract in 30% of healthy subjects. It is a rare disease with an incidence of 5 / 100,000. Most of the time it presents as a complication to the use of bisphosphonates or immunosuppression as ma-lignancy or diabetes mellitus and rarely to oral procedures.

Les cellulites cervico-faciales d'origine dentaire: approches diagnostique et thérapeutique

BUT : Etudier le profil épidémiologique, clinique et para clinique des cellulites cervico-faciales d'origine dentaire ainsi qu'évaluer leur prise en charge thérapeutique et leur évolution.MATÉRIELS ET MÉTHODES : Etude rétrospective ayant inclus 71 patients pris en charge pour cellulite cervico-faciales d'origine dentaire entre janvier 2011 et Décembre 2015. Nous avons relevé les données épidémiologiques, les données cliniques et para cliniques, la prise en charge thérapeutique et l'évolution.RESULTATS : Les cellulites cervico-faciales d'origine dentaire ont été observées à tout âge, le sex-ratio était de 1,02. Un faible niveau socio-économique a été constaté chez 71,8% des patients. Les signes fonctionnels les plus fréquemment retrouvés étaient la tuméfaction (100%), l'algie dentaire (87,3%) et le trismus (81,7%).Les localisations génienne basse et sub-mandibulaire étaient les plus fréquentes avec respectivement 33,8% et 28,1% des cas.La radiographie panoramique dentaire était la plus pratiquée (69%). Elle a contribué à identifier la dent causale et à évaluer l'état dentaire global.Un traitement médical exclusif à base d'antibiotiques a été instauré chez 57,7% des patients et un traitement médico-chirurgical chez 42,3%. Une évolution favorable a été notée pour la quasi-totalité des malades. Un seul patient est décédé.CONCLUSION : La cellulite cervico-faciale d'origine dentaire est une pathologie potentiellement grave dont la prise en charge est coûteuse et les répercussions socio-professionnelles et économiques sont lourdes. Une politique de prévention efficace et ciblée permet de réduire la morbidité liée à ce type d'infection

Cervicofacial necrotizing fasciitis of odontogenic origin following chemotherapy: a case report and implications for oral care in cancer treatment

Objective: Cervicofacial necrotizing fasciitis (CNF) is a rapidly spreading and often fatal infection of the soft tissues of head and neck characterized by tissue necrosis and profuse purulent discharge. This report describes a cancer patient, who had undergone chemotherapy and developed CNF of odontogenic origin to highlight the need for oral examination before commencement ofchemotherapy.Case description: A 68 years old retired gardener who developed CNF from infected right permanent mandibular first and second molars. He had undergone surgery and had 3 cycles of Cisplatin, 5-Fluorouracil and Adriamycin on account of carcinoma of the head of pancreas. No oral assessment was carried out prior to commencement of chemotherapy to detect a potential source of infection. Management included removal of the causative teeth, incision and drainage, repeated debridement, daily dressing of wound with Povidone-iodine solution and intravenous antibiotic based on pus microscopy, culture and sensitivity report. He however succumbed to the disease 23 days later. Conclusion: CNF of odontogenic origin is an extremely fatal condition. Early detection and prompt aggressive treatment is a key to successful outcome. Clinicians involved with management of cancer patients should routinely seek the expertise of a dentist for a pre-chemotherapy oral assessment and all potential sources of infections are removed before chemotherapy begins

Actinomicosis orofaríngea como diagnóstico diferencial de carcinoma de cavum: Reporte de un caso / Cervicofacial actinomycosis as differential diagnosis of cavum carcinoma: case report

La actinomicosis es una enfermedad infrecuente en pediatría que implica, habitualmente, un desafío diagnóstico. Es producida por bacterias del género Actinomyces. La forma cervicofacial suele originarse tras la disrupción de la mucosa oral secundaria a alteraciones odontógenas. Se presenta el caso de una adolescente que, tras la colocación de un piercing en la lengua, comenzó con odinofagia y cambios del tono de voz. Luego de ocho meses de persistencia de los síntomas y habiendo realizado múltiples tratamientos antibióticos con leve mejoría, se efectuó una biopsia y se diagnosticó carcinoma de cavum, por lo que se derivó a este Hospital para su tratamiento. Al analizar nuevamente la biopsia, se descartó la patología oncológica y se diagnosticó actinomicosis orofaríngea. Cumplió 6 meses totales de tratamiento antibiótico, con buena evolución. Si bien la colocación de piercings orales no ha sido descrita hasta el momento como factor de riesgo, la disrupción mucosa generada podría favorecer el inicio del cuadro.

Paediatric actinomycosis is an infrequent infectious disease caused by Actinomyces spp. Cervicofacial infections are usually related to disruption in oral mucosal membranes. We discuss the case of a 15-year-old girl who refers an 8-month history of odynophagia and changes in her tone of voice after getting a tongue piercing. She received multiple antibiotic treatments with slight improvement. Nasopharyngeal carcinoma was diagnosed by endoscopic biopsy. The patient was referred to our Hospital for treatment but, when the biopsy was analyzed again, oncological pathology was excluded and oropharyngeal actinomycosis was diagnosed. She received a total of 6 months of antibiotic treatment with favorable evolution.

Actinomycosis and Sialolithiasis in Submandibular Gland

Actinomycosis is a subacute or chronic suppurative infection caused by Actinomyces species, which are anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and urogenital tracts. Cervicofacial actinomycosis is the most frequent clinical form of actinomycosis, and is associated with odontogenic infection. Characterized by an abscess and mandibular involvement with or without fistula, but the cervicofacial form of actinomycosis is often misdiagnosed because the presentation is not specific and because it can mimic numerous infectious and non-infectious diseases, including malignant tumors. We report a rare case of actinomycosis infection with coexisting submandibular sialolithiasis. The patient presented with a 1x1 cm abscess-like lesion below the lower lip. Punch biopsy of the lesion revealed atypical squamous cell proliferation with infiltrative growth, suggestive of squamous cell carcinoma. The patient underwent wide excision of this lesion, where the lesion was found to be an abscess formation with multiple submandibular sialolithiases. The surgical specimen was found to contain Actinomyces without any evidence of a malignant process. We assumed that associated predisposing factors such as poor oral hygiene may have caused a dehydrated condition of the oral cavity, leading to coexistence of actinomycosis and sialolithiasis.

Cervicofacial Actinomycosis with Orbit Involvement

Actinomycosis is caused by filamentous Gram positive anaerobic bacteria from the Actinomycetaceae family, and known as a rare cause of the infection at the eyeball. We report magnetic resonance findings of a 60-year-old Korean man with cervicofacial actinomycosis, including cellulitis in the eye and central nervous system actinomycosis. On orbital magnetic resonance imaging, gadolinium-enhanced T1-weight images showed multiple abnormal enhancing lesions in head and neck including right eye, and some include low signal intensities which considered as abscesses. The lesions was diagnosed as actinomycosis by incisional biopsy, and since then was cured by using antibiotics of penicillin family.

Osteomielitis mandibular por actinomices: Reporte de caso / Mandibular osteomyelitis by actinomyces: Case report

Se reporta el caso de un paciente varón de 27 años con antecedente de exodoncia compleja de la tercera molar mandibular inferior derecha que presentaba una tumefacción circunscrita dolorosa en la región submandibular ipsilateral. En el estudio imaginológico, la radiografía panorámica presentaba un proceso osteolítico periapical e interradicular con un patrón osteogénico circundante por lo que se utilizó como complemento una tomografía cone beam, en donde se evidenció compromiso desde la rama mandibular derecha hasta la sínfisis mandibular. Las lesiones a nivel de tejidos blandos y tejidos duros fueron diagnosticadas y manejadas como una actinomicosis cervicofacial y osteomielitis crónica supurativa respectivamente. El conocimiento de las diferentes infecciones bacterianas, un adecuado análisis clínico y estudio imaginológico nos darán la pauta para la correcta terapéutica de las distintas patologías maxilofaciales.

A Case of a 27-years old male with a history of complex extraction of right mandibular third molar that had a painful circumscribed swelling in the ipsilateral submandibular region. In imaging studies, the ortopantograph showed a periapical and interradicular osteolytic process with a osteogenic pattern surrounding, so we used a Cone beam Tomography as complement where we found commitment from the right ramus to the mandibular symphsis. Damage at soft and hard tissue were diagnosed and managed as a cervicofacial actinomycosis and supurative chronic osteomyelitis respectively. The knowledge of different bacterial infections, appropriate clinical analysis and imaging studies will lead us to the correct therapy of various maxillofacial pathologies.

Six Cases of Cervical Actinomycosis / 대한이비인후과학회지

Actinomycosis is an unusual subacute chronic disease caused by gram-positive anaerobic organisms such as Actinomycetes israelii, A. bovis, A. odontolyticus, and A. viscosus. Actinomycetes are prominent among the normal flora of the oral cavity. Because these organisms are not virulent, a break in the integrity of mucosa is necessary to cause human illness. Three common forms of illness are cervicofacial, thoracic and abdominopelvic actinomycosis. Cervicofacial form is the most common (55%) and often occurs after oral surgery, tooth extraction and cervicofacial trauma. Cervicofacial actinomycosis is characterized by initial soft tissue swelling, along with development of fistulas that discharge purulent yellow sulfur-like material (sulfur granules). Sulfur granule is the pathognomonic pathologic finding of actinomycosis but it has not been reported in all cases. Here, we report 6 cases of cervical actinomycosis that were trea-ted with surgical intervention and administration of proper antibiotics, with the review of literatures.

A Case of Cervical Actinomycosis Misdiagnosed to Malignant Tumor / 대한이비인후과학회지

Actinomyces are gram positive anaerobes which exist as normal flora in the oral and digestive tract. Actinomycosis is a very rare subacute or chronic infectious disease that causes sinus fistula, tract or abscess due to the invasion of surrounding soft tissue when normal mucosa is damaged by inflammation. Clinically, it is categorized into cervicofacial, thorax, abdomen, pelvis, and systemic infection, in which cervicofacial infection accounts for 50% of all actinomycosis. With various nonspecific clinical manifestations and uncertain results of fine needle aspiration cytology and culture examination, treatment may be difficult since it may be misdiagnosed as malignancy or tuberculosis. Along with literature, we present a case of a 57-year old male patient with cervical actinomycosis in the submandibular mass, which was mistaken for malignancy.

Case Report: Cervicofacial Actinomycosis-Misdiagnosed to Parotid Abscess / 대한이비인후과학회지

Actinomycosis is a disease caused by an anaerobic bacteria called Actinomyces species (predominantly Actinomyces israelii), which is a common and normally nonpathogenic organism found in the nose and throat. The four major clinical presentations of actinomycosis include the cervicofacial, thoracic, abdominal, and pelvic region. Actinomycosis is difficult to diagnose because of variable presentation and fastidious nature of the organism in culture. A high index of suspicion and biopsy are often necessary to make the diagnosis, because the disease can mimic neoplasm or a chronic granulomatous infection. We present, with the appropriate review, a case of actinomycosis in the mandibular angle area which was mistaken for a parotid abscess.

A Case of Submandibullar Sialolithiasis due to Actinomycosis / 대한이비인후과학회지

Actinomycosis is an uncommon disease caused by actinomyces species, which are gram-positive anaerobic bacteria with filamentous appearance. Actinomyces israelii is the most common pathogen resulting in actinomycotic infection. The infection usually presents 3 distinct localizations: cervicofacial, thoracic, abdomino-pelvic. Cervicofacial actinomycosis accounts for about 50% of the cases. The sulfur granule defines the pathognomic pathologic finding of actinomycosis, but it has been reported in only 40% of cases. We report on a case of submandibular sialolithiasis that occurred due to antinomycosis in a 50-year old male patient.

A Case of Actinomycosis Arising in Parotid Gland / 대한이비인후과학회지

Actinomycosis is an unusual granulomatous infection caused by gram-positive organisms (Actinomycetes. israelii, A. naeslundii, A. odontolyticus, and A. viscosus). Depending on the involved anatomical region, actinomycosis is classified into three clinical forms: cervicofacial (the most common, 55%), thoracic, or abdominopelvic. It is still a rare disease constituting less than 1% of all infections and primary parotid actinomycosis is even more rare, indeed. Actinomycosis typically has a chronic, indolent course characterized by swelling and induration of the soft tissues and eventual spontaneous drainage through multiple sinus tracts. The sulfur granule defines the pathognomonic pathologic finding of actinomycosis, but it has been reported in only 40% of cases. Treatment of cervicofacial actinomycosis consists of: removal of the infectious source, such as an infected tooth; incision and drainage, ideally including irrigating drains, and appropriate use of antibiotics and surgery. Our case dealt with a 55-year-old female presenting a firm mass in right parotid area. She was treated with surgical excision and antibiotic treatment.

A Case of Actinomycosis of the Neck / 대한이비인후과학회지

Actinomycosis of cerivcofacial region is an uncommon disease and presents as an abscess or chronic lesion mimicking malignancy, tuberculosis, or fungal lesion. Actinomycosis is difficult to diagnose because of fastidious nature of the organism in culture and general lack of familiarity with the disease. So, a high index of suspicion is required to make an accurate and timely diagnosis. We present a case of male patient with actinomycosis of submandibular triangle complaining of neck mass.

Actinomicosis del hueso maxilar superior / Actinomycosis of the superior maxillary bone

La actinomicosis es una enfermedad crónica de origen bacteriano, del género Actinomyces. Se caracteriza por la presencia de abscesos indurados y voluminosos, además de la existencia de múltiples fístulas de drenaje que pueden localizarse en distintos órganos y tejidos, de preferencia en la región cérvico-facial. Puede presentarse como enfermedad oportunista en pacientes inmunocomprometidos, aunque nuevos estudios rechazan esta teoría. Se presenta un caso de actinomicosis de hueso maxilar superior (AMS) derecho con fistulización hacia el orificio nasal izquierdo. Se revisó bibliografía respecto a la etiología, síntomas, evolución clínica y tratamiento.

Actinomicosis cervicofacial en niños / Cervicofacial actinomycosis in children

La actinomicosis cervicofacial es una enfermedad endógena no contagiosa, supurativa y generalmente localizada con tendencia a la fistulización. Sus agentes etiológicos son bacterias del género Actinomyces cuyo hábitat natural son zonas con baja tensión de oxígeno de la cavidad bucal. La causa desencadenante para que se produzca es el trauma quirúrgico accidental. Es considerada una enfermedad de la edad adulta, sin embargo nuestra experiencia nos permite asegurar que también se produce en la niñez, a partir de la presencia de dientes en la cavidad bucal. El objetivo de esta comunicación es presentar dos casos clínicos de niños derivados a la Cátedra de Microbiología de la FOUBA para realizar el diagnóstico microbiológico de actinomicosis