EURORAD ESR

Case 10759

Actinomycosis of the mandible, possibly related to oral cavity or dental infection

Author(s)
Inês Leite1, Leonor Fernandes1, Filipa Margalho2, Isabel Távora1

1- Serviço de Imagiologia, Hospital Santa Maria, EPE, Lisboa, Portugal
2- Serviço de Cirurgia Plástica, Hospital Santa Maria, EPE, Lisboa, Portugal
 
Patient
female, 19 year(s)
 
 
  • Figure 1
    Lateral cephalogram before orthognathic surgery.

    Severe mandibular retrognathia with open bite was evident.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    Axial contrast-enhanced CT examination (A-C).

    Left-sided sinus fistula at the subcondylar region (1B;arrow) and ill-defined swelling of parotid gland and sternocleidomastoid muscle. An inactive fistula track was also seen on the opposite side (1C;arrow).

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    Axial (A, D, E) and parasagital (B, C) CT.

    Chronic mandibular osteomyelitis (A-D) mainly affecting both ascendant ramus and condylus and causing temporomandibular joint destruction bilaterally (B, C). Delayed healing after right upper third molar extraction...

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    Axial contrast-enhanced CT examination (A) performed 5 years after treatment.

    The inactive fistulae tracts can still be depicted in both subcondylar regions (black and white arrows), but no associated inflammatory changes are noted in the adjacent tissues.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 5
    3D CT lateral views, before (A) and after (B) treatment.

    The almost ideal jaw position was achieved at the end of the treatment, as demonstrated in the fixation period.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
Severe mandibular retrognathia with open bite was evident.
 
Left-sided sinus fistula at the subcondylar region (1B;arrow) and ill-defined swelling of parotid gland and sternocleidomastoid muscle. An inactive fistula track was also seen on the opposite side (1C;arrow).
 
Chronic mandibular osteomyelitis (A-D) mainly affecting both ascendant ramus and condylus and causing temporomandibular joint destruction bilaterally (B, C). Delayed healing after right upper third molar extraction (air bubble;E) is also suspicious for osteomyelitis.
 
The inactive fistulae tracts can still be depicted in both subcondylar regions (black and white arrows), but no associated inflammatory changes are noted in the adjacent tissues.
 
The almost ideal jaw position was achieved at the end of the treatment, as demonstrated in the fixation period.
 
 
 
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