Tuberculous osteomyelitis of the mandible: a case report

Can Oral TB develop in susceptible individuals after an oral surgical procedure? 3 case reports

As opposed to the popular assumption, there have been an increase in the cases of Oral Tuberculosis as of late. Owing to increased drug resistance, there has been a change in the disease pattern leading to an upsurge in the Extra-pulmonary Oral Tuberculosis. According to the WHO, Diagnosis is the first step in the control of TB; but due to the lack of pathognomonic signs associated with Oral Tuberculosis and the rarity of these lesions, diagnosis is often difficult. So, to enable a timely diagnosis, we point out the occurrence of such lesions in the post-operative refractory lesions in susceptible individuals. However, a thorough search of literature did not yield any conclusive results. In this paper we present the clinical, radiographic and histopathological findings of three cases between the ages of 5 and 50 years old who were diagnosed of Oral Tuberculosis. These patients have undergone a recent oral surgical procedure prior to the development of Oral TB lesions. More research is required to increase the awareness of the pattern of this disease and to enable a quicker diagnosis so that the overall morbidity and mortality is reduced.

Post-traumatic tuberculosis of Zygoma - An uncommon presentation

Tubercular osteomyelitis of mid-facial bones is extremely rare because of its immense vascular supply. Due to rare incidence, myriad presentation, and lack of specific symptoms, this condition presents a challenge in diagnosis and calls for acute clinical awareness. This article presents a case report of a 31-year-old martial artist with complaints of trauma to his right malar region since one month and a gradually increasing swelling below his right eye for 3 weeks without any discharge. A diagnosis of primary Tuberculosis of right zygomatic bone was made with the help of multiple diagnostic tools. The patient was treated with four drug anti-tubercular therapy and responded with complete recovery from disease.

Granulomatous diseases: Oral manifestations and recommendations

Granulomatous diseases may present with oral manifestations that are detectable by dental care providers. In certain cases, oral manifestations may precede systemic signs and symptoms. Dentists managing patients with these conditions may modify the dental treatment plan and possibly retain the support of other health professionals. This review gives an update on granulomatous diseases that can be faced by the dental practitioner.

Tuberculous Infection and Exodontia: A Diagnostic & Treatment Dilemma

Tuberculous infection is more common in developing countries which are often overlooked by most of the doctors due to improper medical case history. This causes further complications as they proceed with their procedure. Till date, in dentistry, 90 such cases have been reported in literature. Hence, a dentist should be suspecting preexisting tuberculous osteomyelitis or postextraction complications from such an infection in patients with a positive history of tuberculous infection. Diagnosis as such is often overlooked despite a high prevalence of the disease in high-burden countries such as India. We report this case because of the rarity of its clinical presentation, which was misdiagnosed as odontogenic problem instead of preexisting tuberculous osteomyelitis in the mandibular retromolar region.

Pediatric Primary Tuberculous Osteomyelitis of the Mandible Mimicking Parotitis

Tuberculosis (TB) is a worldwide public health problem; however, primary tuberculous osteomyelitis involving the mandible is extremely rare. Here, we report a 14-year-old boy who presented with a recurrent, generalized swelling of the cheek in the right side, mimicking parotitis. Fine needle aspiration cytology (FNAC) from the swelling was inconclusive. Contrast-enhanced computed tomography (CECT) of the head and neck revealed an osteolytic lesion of the mandible with a surrounding abscess. An intraoral incisional biopsy of the tissue showed a granulomatous lesion. The patient was started on anti-tubercular therapy (ATT) for six months. Our patient's presentation underscores the clinical difficulty in establishing a diagnosis and considering tuberculous osteomyelitis in the differential diagnosis.

Mycobacterium tuberculosis as a cause of mandibular osteomyelitis in a young woman: a case report

Background

Tuberculosis is considered an emerging disease worldwide; in the last 10 years, its incidence has increased to more than 9.6 million cases of active tuberculosis. In 2014, it resulted in 1.5 million patient deaths. However, oral presentation with bone involvement occurs in less than 3% of all reported cases and rarely arouses clinical suspicion on initial presentation.

Case presentation

A 15-year-old Mexican girl who had a previous diagnosis of neurofibromatosis presented to our hospital with pain and swelling in the region of the left mandibular body since November 2011. A clinical examination revealed pain in the mandibular region, a mass of soft consistency that seemed to involve bone, and a fistula with discharge of intraoral purulent material. Additionally, tachycardia and hyperthermia were observed. The left submental and submandibular regions had a 12-cm-diameter swelling, which was well-delineated and nonerythematous. The final diagnosis was established by real-time polymerase chain reaction.

Conclusions

The final diagnosis of rare cases of tuberculous osteomyelitis in the jaw can be established by deoxyribonucleic acid (DNA) identification of Mycobacterium tuberculosis in the lesion. Simple and fast complementary diagnosis by real-time polymerase chain reaction is a fundamental approach to establishing early and effective pharmacological and surgical treatment.

Primary tuberculous osteomyelitis of the mandible in a 3-year-old child

A 3-year-old girl child presented with swelling in her right lower jaw that had started 5 days previously. History revealed the child being non-immunised. Initial-evaluation revealed proptosis and bony hard swelling over the right body of the mandible. Radiological evaluation including a CT scan indicated expansile osteolytic lesion involving the body-ramus with onion-peel periosteal reaction suggesting osteomyelitis/malignancy. Blood investigations showed raised erythrocyte sedimentation rate and eosinophilia. Family screening for tuberculosis (TB) revealed that the patient, her father and siblings were PPD positive though chest screening and sputum examinations were negative in all of them. Lesion biopsy showed acute/chronic osteomyelitis with eosinophilia, tilting diagnosis towards eosinophilic granuloma/Hand-Schuller-Christian disease. Further investigations for diabetes insipidus, histiocytosis-X, skull-pelvic-femur radiographs, abdominal ultrasonography, ophthalmic consultation and PCR-TB test were negative. Histology, radiography, purified protein derivative (PPD)-positive result and history led to the diagnosis of primary TB of the mandible. Complete resolution occurred following antitubercular therapy. The case report emphasises that diagnosis of TB can sometimes be based on circumstantial evidence and positive response to antitubercular therapy even in view of a negative PCR result.

Primary Tuberculous Osteomyelitis of the Mandible Mimicking a Parotid Gland Abscess

Tuberculosis has become a rare disease in the developed countries but it is still a serious problem in the developing countries. Incidence of tuberculous osteomyelitis of the jaw bones is very low. This rare incidence is the primary reason that the lesion gets misdiagnosed many times. Here we report the diagnosis, treatment and follow up of a case which is not a classical presentation of tuberculous osteomyelitis of mandible. Early diagnosis of tuberculous osteomyelitis will certainly reduce the morbidity of this disease condition.

Orofacial tuberculosis: Clinical manifestations, diagnosis and management

Orofacial tuberculosis (TB) is an uncommon form of extrapulmonary TB and is nonspecific in its clinical presentation. It can be misdiagnosed especially when oral lesions are present before systemic symptoms become apparent. Doctors especially attending dentist who generally is the first among clinicians to come across such pathological entity should be aware of the orofacial lesions of TB and consider them in the differential diagnosis of suspicious oral lesions to ensure early diagnosis of TB and its treatment. In this review, we have discussed in detail the clinical presentation of various forms of orofacial TB, diagnosis, and management of patients. Also, an update is provided about recent anti-TB drug development.

Tuberculous osteomyelitis of the maxilla: A rarest of rare case report

Tuberculosis is a chronic granulomatous systemic infectious disease caused by Mycobacterium tuberculosis. The oral lesions found in tuberculosis are relatively rare and may present as ulcers, erythematous patches, indurated lesions, nodules or as bony jaw lesions. Oral tubercular lesions sometimes present a confusing clinical presentation and can be overlooked. Hence, we document a case of tuberculous osteomyelitis of the maxilla in a 19-year-old female patient, who was initially treated for multiple periodontal dental abscesses, which later proved to be tubercular osteomyelitis of the maxilla. Although it is a rare occurrence, the differential diagnosis of tuberculous osteomyelitis must always be considered when it fails to respond to routine therapy.

Primary tuberculous osteomyelitis of the mandible: A rare case report

Tuberculosis (TB) has become a rare disease in the developed countries but it is still a serious problem in developing countries. Incidence of tuberculous osteomyelitis of the jaw bones is very low. This rare incidence is the primary reason that this lesion gets mis-diagnosed many times. Here we report the diagnosis, treatment and follow-up of a case, which is a classical presentation of tuberculous osteomyelitis of mandible. Primary tuberculous osteomyelitis is a very rare entity but in the recent times, increased incidence of TB as a coinfection of HIV, has posed a big challenge in developing countries. If not diagnosed, at the right time, this can lead to serious complications like internal organ damage, tuberculous meningitis etc., Early diagnosis of tuberculous osteomyelitis will certainly reduce the morbidity of this disease condition.

Oral tuberculosis involving maxillary gingiva

Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis, which is transmitted by aerosolized saliva droplets among individuals in close contact with expelled sputum of a diseased patient. However, TB lesions of the oral cavity are often overlooked in the differential diagnosis. We report here a case of tuberculosis of oral cavity affecting the gingiva of a 24-year-old male.

Oral tuberculosis: unusual radiographic findings

Oral tuberculosis and its radiographic findings are not commonly encountered in an oral and maxillofacial radiology practice. Literature has occasional mention of the radiographic findings of oral tuberculosis, which are still ambiguous. When affected, it is manifested majorly in the oral mucosa and rarely in the jaw bones. Here, we report certain unusual radiographic findings of oral tuberculosis which have been rarely mentioned in the literature. Four illustrative cases describe bony resorption, condylar resorption, resorption of the inferior border of the mandible and rarefaction of the alveolar bone as radiographic findings of oral tuberculosis. Follow up of the first case demonstrated regeneration of the condylar head after anti-Kochs therapy was completed, a hitherto unreported phenomenon. The importance of including tuberculosis in the differential diagnosis of some of the unusual radiographic manifestations is emphasized.

Tuberculosis

Approximately one-third of the world population is infected with Mycobacterium tuberculosis, the organism that causes tuberculosis (TB). After a brief resurgence beginning in the mid-1980s, the incidence of TB is once again declining in the United States. Health care workers, including dentists and their staff, however, remain at risk for occupational acquisition of the disease. This risk can be managed by educating dental health care workers about the oral and systemic manifestations of TB and the mechanisms by which it is spread so that appropriate measures may be taken in the office to minimize the opportunity for disease transmission.