Surgical Management of Severe Mandibular Actinomycosis: Segmental Mandibulectomy and Fibula Free Flap for Optimal Outcomes

TL;DR

This paper discusses a severe case of mandibular actinomycosis treated with surgery and reconstruction, resulting in good functional and aesthetic outcomes.

Contribution

The novel contribution is the successful use of segmental mandibulectomy and fibula free flap in treating antibiotic-resistant mandibular actinomycosis.

Findings

Aggressive surgical resection was necessary for antibiotic-resistant mandibular actinomycosis.

Immediate reconstruction with a fibula-free flap provided favorable functional and aesthetic outcomes.

Abstract

Actinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.

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