A Case of Maxillary Actinomycosis

Abstract

Actinomycosis is a very rare infectious disease caused by Actinomyces, which are gram-positive, predominantly anaerobic, non acid-fast bacillus. Actinomyces are normal flora in the upper and lower aerodigestive tracks but can become pathogenic after mucosal injuries such as tooth extraction and trauma to the mouth or jaw. Actinomycosis of the maxillary sinus is very difficult to diagnose due to its low incidence and lack of characteristic clinical findings. We recently experienced a case of maxillary actinomycosis in a 78-year-old immunocompetent male who underwent endoscopic sinus surgery 10 months previously and a molar tooth extraction 3 months previously. CT scans showed soft tissue density with a focal calcification and flexible fiberscopy indicated a brown-colored mass at the maxillary sinus floor. The maxillary sinus lesion was removed by sinus irrigation through the ostium and histopathology confirmed sulfur granules compatible with actinomycosis. The patient was treated with a 6-month course of oral augmentin-clavulanate. A diagnosis of actinomycosis should always be considered in a patient with unilateral intractable maxillary sinusitis, focal calcification in CT scans, and a history of molar tooth extraction.