Cervicofacial actinomycosis following third molar removal: case-series and review.

Actinomycosis is an opportunistic infection caused by bacteria of the Actinomyces spp., commonly A. israelii. These are non-pathogenic commensals in the mouth, gut, and female genital tract. An infection may arise following trauma or surgery, such as tooth extraction. More than half of cases of actinomycosis occur in the perimandibular area and are termed cervicofacial actinomycosis. Initially, the infection develops as a painful, rapidly progressive swelling. The lesion may then indurate and is often painless while the overlying skin discolors red to purple-blue. Prolonged treatment with antibiotics and surgery are often required for resolution, unless treatment is promptly started. However, diagnosis may be delayed or missed because of difficult bacterial culturing and frequent confusion with malignancy and other infections. This case study describes six patients who developed cervicofacial actinomycosis following third molar extraction. The purpose of this study is to inform clinicians on this stubborn and deceitful disease entity and to highlight the importance of clinical recognition for quick resolution with minimal morbidity.

Apical actinomycosis: case report.

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontic therapy. After conventional root canal therapy of the lower left first and second molars, a 24-year-old woman presented with a persistent periapical lesion associated with one of the sinus tracts. The lesion was surgically removed, and actinomycosis was diagnosed on the basis of biopsy results. The clinical and histologic features of this rare condition are discussed.

An unusual manifestation of actinomycosis infection of the maxilla.

Postoperative actinomycosis infection caused by Actinomyces israelii is uncommon. Cervicofacial actinomycosis may appear as an opportunistc infection in the oral cavity. Initial diagnosis of this condition is difficult after oral surgery and the condition often is mistaken for more common odontogenic infections. Actinomycosis responds to antibiotic therapy but the condition recurs after therapy is discontinued. This article presents an unusual case of postsurgical actinomycosis that manifested in the cheek and appeared to be unrelated to the surgical extraction of an impacted maxillary third molar that had occurred one year earlier. The organism was sampled under anaerobic conditions, isolated, and diagnosed by Gram's stain and culture tests. The condition was cured after extraoral surgical drainage, debridement, and several months of oral antibiotic administration.

Periapical actinomycosis: a review.

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontically treated teeth. This case report shows the classic clinical picture of periapical actinomycosis: persistent periapical disease with recurrent sinus tracts. Although there was no pain or swelling after clinically acceptable initial endodontic treatment, a periapical lesion developed. After retreatment, the periapical lesion persisted, and a sinus tract developed. The sinus tract healed with antibiotic therapy but recurred within a few months. This cycle of sinus tract to antibiotic therapy to recurrence of the sinus tract repeated several times over a period of 5 years. Upon biopsy, periapical actinomycosis was diagnosed, where classic "sulfur granules" were demonstrated in the histologic examination of the periapical lesion. Antibiotic therapy for a period of 6 weeks was prescribed subsequent to the histologic diagnosis because of the possibility of spread of the actinomycotic infection into the maxillary sinus. Considerable healing was evident within 5 months of surgical and antibiotic treatment.

[Intracranial actinomycosis in a child with dental caries]. / Intracraniële actinomycose bij een kind met een carieus gebit.

A diagnosis of intracranial actinomycosis was made in a 9-year-old boy with headache, cranial nerve dysfunction and ataxia. Poor dental hygiene leading to caries and an inflammation in his right upper jaw probably was the cause of cervicofacial actinomycosis with intracranial extension. A full recovery was achieved by treatment with benzylpenicillin. Actinomyces is a gram-positive bacterium belonging to the endogenous flora of the mucous membranes of the oropharynx, gastrointestinal tract, and female genital tract. Disruption of the mucous membrane is the portal of entry for an extremely destructive infective process that is effectively treated with penicillin. Good orodental hygiene is important for the prevention of actinomycosis.

[Actinomyces parotid infection after mandibular third molar extraction]. / Infezione parotidea da actinomyces successiva a estrazione di terzo molare inferiore.

Actinomycosis is currently an uncommonly diagnosed human disease. The disease is a chronic suppurative infection caused by micro-organism from the Actinomyces group, most often Israelii. A patient with cervicofacial actinomycosis generally reports a history of recent dental treatment which, usually, involves extraction of a mandibular molar. The common initial signs and symptoms of infection (such as sudden onset of cervicofacial pain, swelling, erythema, edema and suppuration) can be absent. In this case report a 29-year-old man presented a mass in his left parotid area, 1 week after mandibular molar extraction. Echography and CT scans revealed a parotid abscess area. The needle-biopsy of swelling revealed infection due to Actinomyces. Therapy was started with intravenous cefazolin (fl 1g X 2 in 100 s.s. i.v.) and methylprednisolone (25 mg tablet, 1/die) for 9 days; 14 days after treatment suspension the lesion reappeared with a fistula and a new therapy was given (ceftriaxone 1 g/die and gentamicin 80 mg/i.m. for 3 weeks). To prevent a relapse, the patient received cefalexin 1 gx2/die per os for 4 weeks. After a follow-up of 1 year, the patient was still asymptomatic.

Actinomycosis as a rare complication of orthognathic surgery.

Modern orthognathic surgery is said to be clean contaminated due to the intraoral means of access. Complications after orthognathic surgery, a common operation, occur about 10% of the time. Actinomycosis, a rare specific infection, plays a negligible role. Diagnostically, it should be differentiated from other infections that occur a long time after the operation. Three cases of actinomycosis that occurred after orthognathic surgery were observed, and therapeutic measurements are described case by case.

Actinomicosis. Consideraciones clínicas, diagnósticas y terapéuticas. A propósito de dos casos / Actinomycosis. Clinical, diagnostic and therapeutic considerations. About two cases

Las infecciones por actinomices afectan de forma prioritaria a la región cervicofacial, según las series del 32-55 por ciento del total se desarrollan a ese nivel. Las especies que con más frecuencia las provocan son Actinomyces israelii (78 por ciento) y Arachnia propiónica. Clásicamente se describen formas de actinomicosis de presentación aguda o de desarrollo crónico. Presentamos dos casos de actinomicosis desarrollados en pacientes varones de edad media, provenientes de medio rural. Describimos en primer lugar un caso provocado por el Actinomyces meyeri, en la forma clínica de presentación aguda. Se manifiesta bajo la forma de absceso laterocervical del lado derecho. El segundo caso clínico está localizado en el dorso de lengua y suelo de boca, provocado por el Actinomyces odontolíticus. Su desarrollo acontece lentamente simulando un tumor en ambas localizaciones. Aunque ambos casos corresponden a prototipos clínicos de la actinomicosis los actinomices que las provocan raramente son citados en la literatura médica al respecto (AU)

Cervicofacial actinomycosis after partial mandibular resection: case report.

An unusual case of cervicofacial actinomycosis in a 60-year old male Nigerian is reported. The patient had had partial mandibular resection for plexiform ameloblastoma one year earlier with insertion of Kirschner wire to serve as a splint. The authors highlight the possible pathophysiology of this condition. It is suggested that clinicians be aware of the various modes of presentation and natural history of the disease to facilitate prompt diagnosis and appropriate treatment. This will assist in forestalling the numerous complications that may result from actinomycosis.

Actinomycosis cervicofacial. Revisón de la literatura. Reporte de un caso de paciente alérgico a las penicilinas y sulfonamidas / Cervicofacial actinomycosis. Review of the literature. Report of a case of a penicillin and sulfonamide allergic patient

La actinomicosis cervicofacial es una infección de origen bacteriano, crónica y supurativa, que afecta la región facial, cuello y piso de boca. Su evolución está acompañada por la formación de múltiples fístulas alrededor de la lesión que drenan unos gránulos de azufre. Afecta en un 60 por ciento la región facial y los sitios anatómicos que involucra con mayor frecuencia son: maxilar inferior, maxilar superior, glándula parótida, lengua, seno maxilar, ganglios y hueso alveolar. El diagnóstico se hace a través del examen clínico, examen directo, cultivo del microorganismo y estudio histopatológico. Su tratamiento consiste en la administración de altas dosis de penicilinas, drenaje del absceso y cirugía. Se trae a consideración un caso de paciente femenina de 52 años de edad, con antecedentes alérgicos a la penicilina y sulfonamidas, que presenta una lesión nodular en piel del borde inferior mandibular derecho. El diagnóstico de la enfermedad se hace a través de la evaluación clínica, anamnesis y examen directo. Se aplica antibioticoterapia según el caso, drenaje del absceso y evaluación de la paciente a los tres meses. Los hallazgos reportados concuerdan con la literatura consultada

[Mucormycosis-actinomycosis and caseous dental sinusitis associated with sinusal foreign body]. / Mucormycose-actinomycose et sinusite caséeuse dentaire avec corps étranger intra-sinusien.

The authors report an uncommon case of caseous dental sinusitis with infection or superinfection by mocorales and actinomycetes. The patient was healthy, without diabetes mellitus, but was treated for lymphoma 18 years before. This observation leads to a discussion of nosologic, diagnostic and therapeutic features of caseous sinusitis, dental or not, fungal or not, which are often or too often called aspergillosis sinusitis. The recovery of the patient was complete after surgery, amphotericin B and hyperbaric oxygen.

Nonhealing extraction site due to Actinomyces naeslundii in patient with AIDS.

There are many oral complications of human immunodeficiency virus infection. One of the infectious sequelae is contamination and delayed healing of the tooth extraction site. We report a case of a nonhealing extraction site in a patient with the acquired immunodeficiency syndrome. Histologic and microbiologic evaluation determined the causative species of bacterium to be Actinomyces naeslundii. Diagnosis and treatment are discussed.

Cervicofacial actinomycosis in a patient treated for tonsillar carcinoma.

A 50-year-old patient who underwent locoregional radiotherapy and surgery for a tonsillar carcinoma, developed osteomyelitis with Actinomyces israelii with fistulization in the treated area, during chemotherapy treatment. This rare complication is discussed.

[Cervicofacial actinomycosis. Apropos of 5 cases]. / L'actinomycose cervico-faciale. A propos de 5 cas.

Concerning five observations of cervico-facial actinomycosis in the O.R.L. ward of Charles-Nicolle hospital, authors report sings, diagnosis and bacteriology. The cure consists in the extracting of the teeth concerned, the removal of the necrosed tissues and an antibiotherapic treatment based on ligh doses of penicillin relaying with cyclins.