A Case of Actinomycotic Osteomyelitis of the Mandible Treated by Segmental Resection Including the Condylar Process

Abstract

Actinomycotic osteomyelitis of the mandible is a rare disease and often is difficult to diagnose and treat. We report a case of actinomycotic osteomyelitis of the mandible treated by segmental resection. An 83-year-old man was referred to our hospital because of swelling and pain of the mandible. An X-ray examination revealed bone destruction of the left side of the mandible. In the affected bone marrow, magnetic resonance imaging revealed a heterogeneously lower intensity on the T1-weighted image (T1WI) and a heterogeneously high intensity on the T2-weighted image (T2WI). Bone scintigraphy demonstrated accumulation of technetium-99m methylene diphosphonate (^99mTc-MDP) in the region of bone destruction. We administered antibiotics and performed the following two surgical treatments: intraoral sequestrectomy and extraoral decortication. Despite those treatments, the inflammatory condition continued; therefore, we performed a segmental resection of the mandible including the condylar process. Histopathologic examination of the resected specimen revealed some colonies of actinomycotic organisms in the inflammatory granulation tissue of the sequestra. Reconstruction of the mandible was not performed because of its infectious state, and the occlusal status was maintained with a metal guidance flange. The postoperative course was uneventful, and no recurrences were observed during the three-year follow-up period.