The treatment for orofacial TB is the same as standard antimycobacterial treatment regimens used for treating pulmonary TB. Treatment is based on culture and sensitivity data and should include at least four first-line agents (eg, isoniazid, rifampin, ethambutol, pyrazinamide) during the intensive phase, followed by continued treatment (usually with isoniazid and rifampin). No consensus guidelines detail a precise regimen or duration for TB osteomyelitis treatment.
In this case, due to the presence of TB infection involving soft and hard tissues, streptomycin injections were recommended to fight infection after the sensitivity test. This specific antibiotic can reach an optimum therapeutic dose inside soft and hard tissues.
The opening and pain of the lesion were dramatically reduced in weeks, and it completely closed in 3 months. Treatment continued for a further 6 months, using the normal combined regimen (excluding streptomycin) until total bone healing was obtained.
This case is a reminder that histopathology and other laboratory tests may be useful in considering tumors or cysts alongside infections.
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