Head and Neck Imaging

Actinomycosis, cervicofacial manifestation

disease caused by the bacterium Actinomyces israeli, usually arising in patients with poor oral hygiene. Although in its cervicofacial location actinomycosis usually has a dental origin, soft tissue disease is the most common clinical presentation. It has a predilection for the mandibular angle. It starts as an nonspecific inflammation, but after some time scarring, fistulization and subcutaneous infiltration occurs, with progressive extension of the disease. The exudate may contain yellow granules ('sulphur granules'), corresponding to microcolonies of bacteria. Salivary gland actinomycosis, by retrograde extension of the infection, is rare. Actinomycosis may cause sinonasal and pharyngeal disease. In the larynx, actinomycosis may on rare occasions produce an image resembling laryngeal chondronecrosis. Actinomycosis is responsive to penicillin. Imaging is useful to determine the extent of bone and soft tissue disease, and to evaluate the results of treatment. For a general description of the disease, see actinomycosis.

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