Yenson A, deFries H O, Deeb Z E
Otolaryngol Head Neck Surg. 1983 Apr;91(2):173-6. doi: 10.1177/019459988309100211.
Actinomyces israelii is a part of the human oral flora and thus is more commensal than pathogenic. Oral trauma, accidental or purposeful, can precipitate its introduction into the soft tissues, to which infection is usually confined. The case presented is one in which, over a span of two decades (1956 to 1977), the extraction of a mandibular tooth resulted in a chronic actinomycotic osteomyelitis, destroying first the mandible, then both maxillae, and then the right zygoma, with decreased vision and proptosis despite repeated medical and surgical intervention. Adequate treatment required removal of the sequestrum and excision of all infected granulation tissue, scars, and involucra until healthy bone was exposed. Intravenous penicillin was administered for 2 weeks, followed by a 6-month course of oral penicillin. The patient was followed for 4 years and remained disease free.
衣氏放线菌是人类口腔菌群的一部分，因此与其说是致病菌，不如说是共生菌。无论是意外还是有意造成的口腔创伤，都可能促使其进入软组织，感染通常局限于此。本文所呈现的病例是，在二十年（1956年至1977年）期间，拔除一颗下颌牙导致了慢性放线菌性骨髓炎，首先破坏下颌骨，然后是双侧上颌骨，接着是右侧颧骨，尽管经过多次药物和手术干预，仍出现视力下降和眼球突出。充分的治疗需要清除死骨，并切除所有感染的肉芽组织、瘢痕和骨膜，直至露出健康的骨头。静脉注射青霉素2周，随后口服青霉素6个月。对该患者随访4年，其病情未复发。
