Mandibular actinomycosis mimicking tumor recurrence
Selma Sönmez Ergün
Yasemin Balsever Kural
Received: 20 October 2008 /Accepted: 26 March 2009 /Published online: 16 April 2009
Abstract Actinomycosis is a rare disease caused by a
microorganism of the normal oral flora. Infection is
characterized by swollen tissues and sinuses from which
pus drains containing characteristic sulfur granules. Since
actinomycosis is a tumorous infection of skin and subcuta-
neous tissue, this chronic lesion can occasionally mimic
neoplasia. A male patient is presented; he had a tumor-like
lesion of the left mental region that was initially diagnosed as
tumor recurrence, but proved to be an Actinomyces infection
on histopathologic examination. Excellent therapeutic re-
sponse was obtained with a combination of antibiotic
therapy, surgical debridement, and mandibular curettage.
Vestibuloplasty–commissuroplasty was also performed.
Keywords Mandibular actinomycosis
Actinomycosis is a rare disease that is worldwide in
distribution. In the preantibiotic era, the entity was more
common than it is now. The reduced incidence is related to
widespread use of antibiotics, preventive dentistry strate-
gies, and improved oral hygiene .
It is a chronic, progressive, suppurative, and granuloma-
tous bacterial infection that most commonly manifests as
cervicofacial, thoracic, abdominopelvic, or central nervous
system disease. A variety of gram-positive, nonspore-
forming anaerobic or microaerophilic rods, primarily from
the genus Actinomycetes, are the responsible agents .
Osseous involvement occurs in only 15% of cases.
Osseous actinomycosis usually results from adjacent soft
tissue infection. Periostitis stimulates new bone formation by
periosteal elevation and can be the first clinical sign. When
there is active bone involvement, gradual cortical erosion can
give way to localized lytic bone destruction that is
surrounded by increased bone density. The mandible is the
most common site of actinomycotic infection. The posterior
part of the mandible is more frequently involved than the
anterior part. Adequate debridement would appear to be the
cornerstone of therapy, with all cases reported in the literature
eventually requiring at least one debridement [1, 3–5].
Mandibular actinomycosis in a 53-year-old male patient
with a history of squamous cell carcinoma of the left
commissural region is presented. This was treated with
surgery and radiotherapy.
A 53-year-old male patient was admitted to our hospital
with salivary leakage from a fistulous tract opening located
Eur J Plast Surg (2009) 32:249–252
S. Sönmez Ergün
Department of Plastic Surgery, Vakif Gureba Hospital,
Y. Balsever Kural
Department of Dermatology, Vakif Gureba Hospital,
Department of Radiology, Vakif Gureba Hospital,
Department of Pathology, Istanbul Medical School,
S. Sönmez Ergün (*)
Bahçeşehir Emlak Bankası Konutları,
B 18, D3, C020403, 34 900, Büyükçekmece,