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

Laith Mahmoud Abdulhadi, BDS, CES, DDS

Disclosures

July 13, 2016

The history of unhealed fracture after trauma, the absence of bone expansion, and the presence of chronic resistant infection with purulent discharge in this patient suggested a chronic pyogenic infection, such as TB. This was supported by other clinical features, such as the history of fever and night sweats. Radiography of the lesion was suggestive of either a cystic lesion or tumor; however, the absence of bone expansion and sequestration added to other clinical manifestations was suggestive of TB.

Benign or malignant tumors of the jaw manifest mostly by different radiolucent appearances with or without expansion of the affected region. Malignant jaw tumors may be primary or secondary metastasis, and grow and expand faster compared with a benign tumor or cyst. These conditions should be excluded after complete examination using suitable tests. Culture and sensitivity tests help to establish the exact diagnosis and proper antibiotic therapy.

Chronic TB osteomyelitis may result from acute, poorly treated, or untreated subclinical osteomyelitis; open fractures; surgery for an array of orthopedic conditions; and contiguous spread of infected soft tissue, as may occur in debilitating conditions or trauma. Resistant infection of soft and hard tissues should make the practitioner consider TB as an etiology, such as in this case. This patient clearly had compromised immunity that predisposed toward serious infection with exposure to highly virulent microorganisms.

In this case, the patient was believed to be immunodeficient due to longstanding diabetes and alcoholism. The absence of a pulmonary TB lesion indicated that the TB osteomyelitis might be a primary lesion that occurred at the time of fracture and was complicated by diabetes and alcoholism.[12] Early diagnosis of TB can reduce or even prevent serious complications, including internal organ damage, tuberculous meningitis, and other morbidity.

One of the largest series of orofacial TB was reported by Andrade and Mhatre in 2012.[13] They described 46 cases over 16 years and provided an excellent classification for the different manifestations of this disease. Most patients were in their 20s and 30s. Prior dental trauma, poor dentition, and altered host resistance were commonly observed.

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