Ulcerative Conditions
Actinomycosis
Etiology • An infection caused by one of the Actinomyces group of
bacteria, chiefly the israelii species Clinical Presentation
• Most common site is the mandible, producing cervicofacial disease
• Associated facial pain, paresthesia, low-grade fever, and persistent swelling and discharge
• Bone lesions may be destructive in nature, with accompanying rarefaction and/or sclerosis or periostitis.
Actinomycosis
Etiology • An infection caused by one of the Actinomyces group of
bacteria, chiefly the israelii species Clinical Presentation
• Most common site is the mandible, producing cervicofacial disease
• Associated facial pain, paresthesia, low-grade fever, and persistent swelling and discharge
• Bone lesions may be destructive in nature, with accompanying rarefaction and/or sclerosis or periostitis.
• Cervicofacial form is usually insidious in onset, with a longterm, low-grade course.
• Presents typically as a hard, chronic enlargement of the jaw; extraoral abscess formation may be noted with drainage fluid containing yellow sulfur granules (bacterial colonies)
Diagnosis • Sulfur granules (1–4 mm) in exudate • Peripheral club-like structures in bacterial colonies micro-
scopically • Aerobic and anaerobic culture; actinomyces are anaerobic or
microaerophilic Differential Diagnosis
• Infection: nocardiosis, fungal, staphylococcal, streptococcal • Neoplasm (malignant)
Treatment • Surgical débridement followed by prolonged antibiotic course
(penicillin is drug of choice) • Surgical revision of extraoral drainage sites if indicated
Prognosis • Excellent