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

Primary Mandibular Tuberculous Osteomyelitis Mimicking Ameloblastoma: A Case Report and Literature Review of Mandibular Tuberculous Osteomyelitis

Primary tuberculous osteomyelitis involving the mandible represents less than 2% of skeletal locations. In this paper, we report a case of mandibular tuberculosis (TB) detected after histopathological analysis of the surgically resected specimen during surgical management of a suspected case of ameloblastoma. A 14-year-old male patient presented to us with history of right-sided chin swelling. The clinical examination revealed a swelling, involving right body and parasymphysis of mandible, measuring approximately 6 cm in length and 2 cm in width, extending from right lateral incisor till the first molar. Radiological scans revealed a large multiloculated osteolytic expansive lesion measuring 52 × 20 × 18 mm. Excision of the lesion was performed and reconstruction was done with iliac bone grafting. The histopathological findings revealed a granulomatous lesion, suggestive of tuberculous osteomyelitis. The patient was successfully treated with standard multidrug therapy. One year after completion of therapy, there were no signs of recurrence. Primary mandibular TB is an extremely rare entity. Its clinical presentation is not specific. Radiologically, TB has no characteristic appearance. The positive diagnosis is based on histology. Primary mandibular TB is rare and should be kept among differential diagnoses in susceptible population and in endemic areas.

Primary tubercular osteomyelitis affecting the mandibular condyle - A case report

Rationale:

Primary orofacial tuberculosis (TB) accounts for <3% of all cases of TB. TB of the mandibular condyle is often misdiagnosed owing to its rarity.

Patient Concerns:

This report presents a 19-year-old female who presented with a painful swelling over the right preauricular region. The radiographic evaluation suggested a diagnosis of suppurative osteomyelitis of the condyle.

Diagnosis:

Clinically, the aetiology of the swelling was considered as infective. The histopathological examination of the resected specimen showed tuberculous granuloma and the polymerase chain reaction came positive.This confirms the diagnosis of tubercular osteomyelitis. Mantoux test and sputum acid-fast bacilli were found to be negative.

Treatment:

The patient was subjected to sequestrectomy with high condylectomy and systemic multidrug antitubercular regimen for 6 months.

Outcomes:

There was a resolution of infection postoperatively with subsequent regeneration of healthy bone.

Take-away Lessons:

Early identification and prompt diagnosis is imperative for better treatment outcomes.

Tuberculous osteomyelitis of the mandible impersonating dentoalveolar abscess: a case report

Introduction: Tuberculosis (TB) affects 8 million new people every year, with developing countries under its strong clout. Although tuberculosis can affect any part of the body involving both soft and hard tissues; such an occurrence in the maxillofacial bones in the form of tuberculous osteomyelitis is relatively rare. Due to the rarity of the lesion and lack of sufficient documentation, its incidence can be expected to be more than what has been reported so far. Observation: So, here is a case of a 21-year-old male who presented with pain and swelling on the mandible, diagnosed as tuberculous osteomyelitis after an initial diagnosis of dentoalveolar abscess. Conclusion: As dentists and as oral medicine practitioners, it is of utmost importance for us to be aware about uncommon diseases affecting the jaws such as tuberculous osteomyelitis, which tend to mimic dental infections in some cases to prevent misdiagnosis and provide holistic care to the patient.

Mandibular tuberculosis fortuitously discovered after surgical resection of an ameloblastoma: A case report

INTRODUCTION

Mandibular localization of tuberculosis is rare and represents less than 2% of skeletal locations. Its clinical and radiological features are not specific. In this paper, we report a case of fortuitous discovery of mandibular tuberculosis after a histopathological analysis of the surgical resected specimen during surgical management of an ameloblastoma.

PRESENTATION OF CASE

A 50-year-old female patient was admitted to our department with a 2 years history of left cheek swelling, the clinical examination revealed a left cheek swelling, extending from the mandibular angle to below of temporomandibular joint, measuring approximately 5 cm in diameter. The swelling was firm to hard in consistency, and cervical lymphadenopathy of submandibular region was noticed. Computed tomography (CT) scan revealed a large multiloculated osteolytic expansive lesion measuring 56 ∗ 48 ∗ 53 mm. An interrupting hemimandibulectomy, was performed from the left parasymphys opposite to 33 tooth, extending to the left temporomandibular joint. The histopathological findings confirmed the diagnosis of ameloblastoma, with negative free margin. A mandibular and lymph node tuberculosis were associated with giant cells and caseating necrosis. The patient was successfully treated with a standard anti-tuberculosis therapy.

DISCUSSION

Ameloblastoma is a benign odontogenic tumor, 80% of these tumors are found in the mandible. Primary mandibular tuberculosis is an extremely rare entity. Its clinical presentation is not specific. Radiologically, tuberculosis has no characteristic appearance. However, it is possible to evoke it in case of a lytic image of the mandible. The positive diagnosis is based on histology. The treatment is medical, but surgery is necessary for some cases.

CONCLUSION

The association between ameloblastoma and mandibular tuberculosis represents an extremely rare entity. Mandibular tuberculosis is rare and should be considered as a possible diagnosis in pandemic areas.

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.