A 52-Year-Old Man With a Large Jaw Opening

Laith Mahmoud Abdulhadi, BDS, CES, DDS

Disclosures

July 13, 2016

Discussion

This patient's culture ultimately was positive for Mycobacterium tuberculosis. Tuberculosis (TB) is an infectious, granulomatous disease caused by M tuberculosis in 87.5% of cases or, rarely, by Mycobacterium bovis, which is part of the M tuberculosis disease complex (12%).[1,2] One third of the world's population is infected with TB.[3] A total of 9421 TB cases (2.96 cases per 100,000 persons) were reported in the United States in 2014. The incidence rate is 12.3 per 100,000 in the United Kingdom, mostly in those not born in the United Kingdom.[4]

Orofacial TB is a rare manifestation of extrapulmonary TB, occurring in approximately 0.1%-5% of all TB infections.[5] The oral cavity is affected by TB in two distinct ways. The first is primary involvement, wherein the tubercle bacilli are inoculated into the mucosa of a host who is not previously infected with TB or who has not otherwise acquired immunity to this organism.

The second way to acquire orofacial TB is by hematogenous or lymphatic spread, such as what is observed in lupus vulgaris, which involves the mucocutaneous area around the nostrils, mouth, and eyes.[6] Orofacial TB usually affects the tonsils and tongue (tip and lateral margin), as well as the floor of the mouth, soft palate, and gums. The lips and hard palate are the most frequently affected oral sites.[7] Elephantiasis appearance of the lips is another reported form.[8] Although TB lymphadenitis (scrofula) of the submandibular triangle is considered a secondary focus of infection, a primary location is not always found.[9] Oral TB osteomyelitis is extremely rare in the maxilla. In addition, it can be a primary lesion. Radiographically, it looks like an infected cyst or benign osseous tumor.[10,11]

The risk factors for TB include chronic alcoholism, peptic ulcer, diabetes, steroid therapy, and HIV/AIDS.[2,10] The standard for diagnosis is identification of the M tuberculosis by culture.

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