A Non-Sinus Forming Mandibular Actinomycotic Osteomyelitis with a Submandibular Gland Swelling - A Case Mimicking a Periapical Infection

Abstract

Involvement of the submandibular gland in actinomycotic osteomyelitis in the absence of sinus is rare. Cervicofacial form is characterized by contiguous spread, suppurative osteomyelitic & granulomatous inflammation of the mandible and formation of multiple abscesses and hallmark discharging sinuses draining serosanguinous fluid containing sulphur granules. As the imaging finding of this entity is rarely described, in this case report, a rare case of mandibular actinomycotic osteomyelitis, with a submandibular swelling, but without draining sinus is reported. The imaging findings of cone beam computed tomography (CBCT) & ultrasonography (US) of the case are discussed with a review. In subacute stage, mandibular actinomycosis may show no hallmark sinuses. Sclerotic margins around the lesion may be found on radiograph. Imaging is useful in ruling out clinical diagnostic challenge when it includes involvement of mandible & submandibular region. Cervicofacial actinomycosis commonly occurs as perimandibular infection, rarely as osteomyelitis of the mandible.1 It may present as two distinct morphological patterns; first, "lumpy jaw," and second, simulating an acute pyogenic infection affecting the submandibular area, discharging sinus being a hallmark finding.1 Other variant reported include chronic osteitis, osteolytic lesion, hard nodule on the tongue, lockjaw, periapical, or paradental abscess. Diagnosis of cases presenting in multiple areas in the absence of multiple discharging sinuses is a challenge.2 Usefulness the imaging findings are rarely enumerated. This report is of a twin presentation of a non - sinus forming actinomycotic mandibular osteomyelitis and a submandibular swelling, along with a review of various diagnostic imaging features.