The lumpy jaw. Cervicofacial actinomycosis

Cervicofacial actinomycosis is a unique polymicrobic infection of endogenous origin, displaying a highly variable clinical course, ranging from an acute, suppurative lesion to a chronic fibrotic process more suggestive of a malignancy. Lesions advance with total disregard for tissue planes, producing burrowing sinus tracts to the skin or mucosal surfaces, which often discharge sulfur granules, colonies of Actinomyces species cemented together by host phosphatase activity. The diagnosis is quite elusive when proper studies (anaerobic culture, careful tissue examination and fluorescent antibody stains) are not undertaken in a timely fashion. Most cases respond well to a prolonged course of antimicrobial therapy. Some patients require excision of fibrotic lesions or persistent sinus tracts. Penicillin G is considered the agent of choice on the basis of extensive clinical experience; tetracycline, erythromycin, and clindamycin are effective as alternative agents.