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HEAD AND NECK: HN18

HEAD AND NECK: HN18. L. EL ASSASSE, S. BOUTACHALI, F. AMRAOUI, T. AMIL, S. CHAOUIR, A. DARBI. MANDIBULAR ACTINOMYCOSIS: A REPORT OF TWO CASES. Radiology service, Military hospital, Rabat, Morocco. Introduction: .

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HEAD AND NECK: HN18

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  1. HEAD AND NECK: HN18

  2. L. EL ASSASSE, S. BOUTACHALI, F. AMRAOUI, T. AMIL, S. CHAOUIR, A. DARBI MANDIBULAR ACTINOMYCOSIS: A REPORT OF TWO CASES • Radiology service, Military hospital, Rabat, Morocco

  3. Introduction: • The mandibular actinomycosis is a rare condition, usually secondary to tooth extraction, mucous wound or mandibular fracture. • We report in this work two cases of mandibular actinomycosis explored by orthopantomogram and facial CT and whose diagnosis is confirmed by histology.

  4. Observation and results: • These two patients aged 26 and 60 years, both having a history as a dental extraction with delayed mucosal healing, having presented a mandibular pain with perimandibular tumefaction. • Radiological aspects were not specific with uni or multigeodic osteolysis.

  5. Observation and results: • A wide excision was indicated for them with empiric antibiotic therapy. • Pathological examination of surgical specimens revealed actinomycotic osteitis.

  6. Observation and results: Case 1: Orthopantomogram showing a left pre-angular osteolytic lesion.

  7. Observation and results: Case 1: Facial CT showing well defined multilocular osteolytic lesion in the horizontal branch of left mandible.

  8. Observation and results: Case 2: Orthopantomogram showing a left parasymphyseal unigeodic osteolytic lesion.

  9. Discussion: • The cervicofacial actinomycosis is a rare infectious disease whose incidence is estimated at 5 per 100,000 people. • It is most frequent in adults between 20 and 60 years with sex ratio 3 males to 1 female . • It is caused by germs long regarded as intermediate between fungi and bacteria but which proved to be true bacteria: Actinobacteria or actinomycetes . • Involvement of the head and neck region is the most frequent (50 to 75% of cases), thoracic and abdominal locations are rarer.

  10. Discussion: • Contributing factors sometimes found are poor oral hygiene, oral trauma or surgery , dental procedures and salivary lithiasis. • Chronic tonsillitis, mastoiditis, and otitis are also important risk factors for actinomycosis.

  11. Discussion: • The radiological signs of actinomycotic osteitis are not specific. • Involvement may be osteolytic (uni or multigeodic) or osteoblastic. • The severe forms of mandibular actinomycosis can develop into the skull base or cervical spine.

  12. Discussion: • Diagnosis is histological. • Treatment consists of prolonged antibiotic therapy and surgical debridement. • Prognosis depends on early diagnosis and treatment.

  13. Conclusion: • The diagnosis of actinomycosis should be considered in patient with recurrent and chronic suppuration. • The appearance on imaging is not specific and the diagnosis of certainty is histological.

  14. References: • Chobaut.J.C, Maniere.C. et coll. L'actinomycose en ORL. A propos d'un cas localisé aux fosses nasales. Ann. Oto-laryngol. Chir. Cervicofac. (Paris). 1994, 111 :292-294. • Simony.J, Puissant.A. et coll. Un cas d'actinomycose cervicale évoluant depuis trois ans sans traitement. Ann. Dermatol. Venereol. 1986 ; 113 : 555 – 558. • Del Rosario.N, Rickman.L. Letters. Cervico-facial actinomycosis. Arch. Otolaryngol. Head neck. Surg. 1987 ;113 :777-778. • Gorlin.R.J, Goldman.H.M. (Eds) Thomas oral pathology. St louis, mosby, 1970. • Sodagar.R, Kohoute.E. Actinomycosis of tongue as pseudotumor. Laryngoscop. 1972 ; 81 : 2149 – 2152. 6) Antoine.G.A, Antoine.J.A. Cervicofacial actinomycosis. Ear nose Throat. J. 1986 ; 65 :483-485.

  15. References: • Walker.R.S, Middelkamp.J.N. et coll. Mandibular osteomyelitis caused by actinomyces israelii. Oral. Surg. 1981 ; 51 : 243-244. • Stenhous.D. Intraoral actinomycosis. Report of five cases. Oral. Surg. 1975 ; 34 : 547-552. • Vannier.J.D, Schaison.G. et coll. Actinomycosis osteomyelitis of the skull and atlas with lace dissemintion. Eur. J. pediatr. 1986 ; 145 :316-318.

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