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1/60. Atypical presentations of actinomycosis.

    BACKGROUND: Actinomycotic infections of the cervicofacial region are uncommon. Most major medical centers report approximately one case per year. Presenting clinical manifestations are confusing because they often mimic other disease processes. Diagnosis may be difficult due to a general lack of familiarity with the disease and the fastidious nature of the organism in culture. The cervicofacial manifestations of actinomycosis are varied, and a high index of suspicion is required to make an accurate and timely diagnosis. methods: Retrospective chart review with the presentation of four unusual cases of actinomycosis were performed. RESULTS: Two patients were initially seen with dysphagia from a tongue base mass. The third patient was initially seen with a 3-week history of worsening hoarseness and stridor. Examination revealed an ulcerative lesion of the left hemilarynx and pyriform sinus. All three patients were thought to have a neoplastic process. Diagnosis was made on histologic examination of a tissue biopsy. The fourth patient was initially seen with a buccal space mass that was draining externally. culture of the purulent drainage revealed actinomyces. In all four cases, symptoms resolved after appropriate antimicrobial therapy. CONCLUSIONS: actinomycosis of the head and neck, although rare, is an important entity to the otolaryngologist. A confusing clinical presentation combined with the fastidious nature of the organism make for a difficult diagnosis. A high index of suspicion is required to make an accurate diagnosis and institute the appropriate antibiotic therapy. ( info)

2/60. Case report of regional alveolar bone actinomycosis: a juvenile periodontitis-like lesion.

    BACKGROUND: Cervicofacial actinomycosis infection most often involves the mandibular bone and rarely the alveolar crest. methods: We describe a 14-year-old patient who had actinomycosis involving the alveolar bone at the left lower dental quadrant region. Resembling juvenile periodontitis, it was difficult to diagnose properly and resulted in devastating dental and periodontal consequences: loss of one tooth with most of its adjacent regional alveolar bone, severely compromising the support of two other teeth. RESULTS: With the diagnosis came successful treatment, including surgical removal of the soft and hard tissues with concomitant prolonged penicillin administration. CONCLUSIONS: We feel that this case should raise the interest and concern of both the periodontist and the general practitioner so that early diagnosis can be obtained, significantly improving the clinical outcome. ( info)

3/60. actinomycosis of the frontal and parotid regions.

    Cervicofacial actinomycosis still occurs infrequently and should be included in the differential diagnosis of neoplasms, and chronic suppurative and granulomatous lesions of the head and neck region. The authors present two cases of actinomycosis. Patient 1 was a 32-year-old man who was first seen with a firm, suppurative mass at his left frontal region. Patient 2 was a 36-year-old woman with an indurated mass at her left parotid area. Both patients were diagnosed histopathologically with cervicofacial actinomycosis, but each patient had a different clinical course and different response to antimicrobial and surgical treatments. ( info)

4/60. Pediatric cervicofacial actinomycosis: a case report.

    Cervicofacial actinomycosis in children is a rare disorder. This article reports a case in a 7-year-old-girl. The importance of cervicofacial actinomycosis in the differential diagnosis of cervical masses in young patients is emphasized. ( info)

5/60. Unusual presentation of mandibular extraoral sinus in a fourteen year old girl: a case report.

    A case of fourteen year old healthy girl with complaint of a discharging sinus on the lower right side of face is reported. All teeth were vital and there was no evidence of periodontitis. There was no history of extraction of a tooth. Total leucocyte count, differential leucocyte count, fasting blood sugar, chest x-ray and routine urine examination were within normal limits. actinomycosis and scrofuloderma which simulate such a condition were ruled out by culture study. The intraoral periapical x-ray of mandibular molar showed questionable periapical changes at the time of presentation. But definite osteolysis was observed in the repeat radiograph after three months. It was decided to extract the second molar and curette the sinus tract. The extraction proved to be difficult. On examination of the extracted tooth, it was found that the mandibular second molar and second premolar were fused together. The radiograph of the tooth taken after extraction showed confluence of the premolar pulp with the periodontal membrane. On follow up, the lesion was found to heal satisfactorily. ( info)

6/60. actinomycosis of the post-cricoid space: an unusual cause of dysphagia.

    Cervicofacial actinomycosis is known to affect many soft tissues and bony structures in the head and neck. However to the authors' knowledge, actinomycosis of the post-cricoid region has not been previously reported. A case of a 74-year-old male who developed actinomycosis of the post-cricoid region after radiotherapy for a laryngeal carcinoma is presented. actinomycosis should be considered in the differential diagnosis of dysphagia following radiotherapy for squamous cell carcinoma of the larynx, as early treatment is likely to result in a favourable outcome. ( info)

7/60. Cervicofacial actinomycosis.

    Cervicofacial actinomycosis is a disease that is currently encountered as a pseudotumor entity or cold abscess. The frequent use of antibiotics in treatment of masses in the cervicofacial region may either delay its appearance or disguise the diagnosis. The surgeon must be highly suspicious when making the diagnosis since precautions in handling the biopsy specimens are necessary. Treatment consists of incision biopsy and drainage or aspiration to establish the diagnosis, followed by prolonged penicillin therapy. In those patients allergic to penicillin, clindamycin should be the initial drug of choice. Either medication must be administered for a prolonged period of time, even after the disease is clinically controlled. ( info)

8/60. actinomycosis of tonsil masquerading as tumour in a 12-year old child.

    A case of unusual presentation of actinomycosis of tonsil causing massive unilateral enlargement, mimicking a tumor in a 12-year old girl is reported. ( info)

9/60. 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. ( info)

10/60. actinomycosis of the face and neck.

    Cervical actinomycosis is a rare condition. During the last six years, five patients were hospitalized in our department, suffering from swelling in the region of the face and neck that was identified bacteriologically as actinomyces israelii. Soft tumors of the head and neck that do not respond to common antibiotic therapy should arouse the suspicion of actinomycosis. ( info)
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