Actinomycosis in the Face and Neck Region; A Report of Two Cases

Abstract

Actinomycosis is a chronic purulent granulomatous disease caused by actinomyces, an organism which is often present in man. Patients with a chronic clinical course have been on the increase in recent years, and differentiating this disease from tumor is often necessary when the mass is in facial and cervical regions other than the oral cavity and jaw. We report two cases of actinomycosis in the face and neck.
Case 1: A 54-year-old man complained of a swelling in the anterior part of the neck. A mass 65 × 70 mm with redness of the skin was noted at his first visit. The mass was of platelike consistency with a smooth surface closely adherent to the surrounding tissue. The tuberculin test was negative. A malignant tumor was considered, so percutaneous needle biopsy was performed, but no significant abnormality was found. Antibiotics were given by drip infusion, and the mass disintegrated. Yellow viscous pus containing light gray granules was discharged to form a fistula.
Case 2: A 40-year-old man developed a swelling in the left cheek. A ping pong ball-sized mass of plate-like consistency with redness was noticed at his first visit. A fistula formed in the oral cavity on the left, and pus was discharged from it. Plain CT revealed an isodense lesion in the left cheek, with no connection to the maxillary sinus.
Actinomyces is anaerobic, so it was not detected by culture in either case. Histopathological examinations of actinomycotic granules was useful in the diagnosis.
The treatment consists mainly of drainage by incision of the lesion and administration of antibiotics, especially penicillin.