Actinomycotic Osteomyelitis of Maxilla Presenting as Oroantral Fistula: A Rare Case Report.

Ashalata Gannepalli,Bhargavi Krishna Ayinampudi,Pacha Venkat Baghirath,G Venkateshwara Reddy

doi:10.1155/2015/689240

Actinomycotic Osteomyelitis of Maxilla Presenting as Oroantral Fistula: A Rare Case Report.

Ashalata Gannepalli, Bhargavi Krishna Ayinampudi + Show 2 more

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https://doi.org/10.1155/2015/689240

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Abstract

Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. This infection spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organ. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. Diagnosis is often delayed and is usually based on histopathology as they are cultured in fewer cases. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3–6 months. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Hence, we present a 50-year-old female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features.

Highlights

Actinomycosis is a rare saprophytic infection that is characterized by granulomatous and suppurative lesions caused by resident oral microbiota, Actinomycetaceae
Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible, probably because of better circulation which provides increased oxygen supply [3, 4]
The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula and palatal perforations is rare [1, 4,5,6,7]

Summary

Introduction

Actinomycosis is a rare saprophytic infection that is characterized by granulomatous and suppurative lesions caused by resident oral microbiota, Actinomycetaceae. Most of the species isolated from actinomycotic lesions have been identified as A. israelii, A. viscosus, A. odontolyticus, A. naeslundii, or A. meyeri [1, 2] It can present in an acute, subacute, or chronic form. It may involve only soft tissue or bone (osteomyelitis) or the two together This infection typically spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organs, producing multiple sinus tracts [2, 3]. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula and palatal perforations is rare [1, 4,5,6,7] It has myriad clinical presentations and is a potentially benign and completely curable disease but if not detected early, it has the propensity to damage extensively. This unusual case shows chronic actinomycotic osteomyelitis of maxilla with suppurative and sclerosing features which presented as oroantral fistula in a 50-year-old female patient

Case Report

Discussion

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