Vigliaroli E, Broglia S, Iacovazzi L, Maggiore C
Oral Surgery, Department of Surgical Sciences, University of L'Aquila, L'Aquila, Italy.
Minerva Stomatol. 2010 Sep;59(9):507-17.
Actinomycosis is an uncommon chronic granulomatous infection that cause formation of abscesses and cutaneous fistula. In mandibular actinomycosis the alveolar bone and mandibular body are usually not involved and the pathogenetic mechanisms of the actinomycotic infiltration is unknown. The patients usually report pain at the alveolar arch with development of a purplish-red swelling firmly attached to the mandibula; the fibrous tissue produces the continued development of new cutaneous fistulas with oncoming pus-secretion. An uncommon case of actinomycotic osteomyelitis with a double pathological fracture of mandibula is reported. Ortopanoramic X-ray and computed tomography scan of the mandibula are effective and relevant diagnostic procedures to quantify the entity and site of the osteolitic areas and to define the precise position of fractures. In association with the intravenous infusion of benzilpenicillina, daily local irrigations of rifamicina have been performed. Moreover, the patient underwent surgical drainage of abscesses with accurate curettage of osteomyelitic lesions and several biopsies of the trabecolar bone and fistulas were taken. It has been also necessary to perform a mandibular blockage using a resinal plaque anchored on premolars. To reach a precise diagnosis, an histopathological examination togheter with batterioscopic-coltural examination is needed. Antibiotic therapy alone is not a sufficient therapeutic approach and surgical treatment must be quickly performed with clean up of the osteomyelitic lesions and contention of fractures by alveolar blockage for at least 40 days.
放线菌病是一种罕见的慢性肉芽肿性感染，可导致脓肿和皮肤瘘管形成。在下颌放线菌病中，牙槽骨和下颌体通常未受累，放线菌浸润的发病机制尚不清楚。患者通常报告牙槽弓疼痛，并出现与下颌骨紧密相连的紫红色肿胀；纤维组织导致新的皮肤瘘管不断发展，并伴有脓性分泌物。本文报告了一例罕见的放线菌性骨髓炎合并下颌骨双病理性骨折的病例。下颌骨全景X线和计算机断层扫描是有效的相关诊断方法，可量化骨质溶解区域的范围和部位，并确定骨折的精确位置。在静脉输注苄青霉素的同时，每日对利福平进行局部冲洗。此外，患者接受了脓肿的外科引流，对骨髓炎病变进行了精确刮除，并对小梁骨和瘘管进行了多次活检。还需要使用固定在前磨牙上的树脂板进行下颌阻滞。为了做出准确的诊断，需要进行组织病理学检查以及细菌镜检和培养检查。仅使用抗生素治疗并不足够，必须迅速进行手术治疗，清理骨髓炎病变，并通过牙槽阻滞固定骨折至少40天。
