Tuberculous osteomyelitis of the mandibular condyle: A rare case report and review of the literature

Abstract

Tuberculosis (TB) is a chronic infectious granulomatous disease caused by the air-borne bacillus Mycobacterium tuberculosis and less frequently by other bacteria in the M. tuberculosis complex (Mycobacterium Bovis and Mycobacterium africanum). Tuberculous osteomyelitis of the condyle may present atypical clinical findings akin to temporomandibular joint arthritis or middle ear infections. A detailed clinical and radiographic examination aided by a histopathological and a microbiological diagnostic workup is the key to timely detection and administration of appropriate therapeutic regimens. A high degree of clinical suspicion is thus advocated in patients with such atypical presentations. We, hereby, are presenting a rare case of tuberculous osteomyelitis in a 15-year-old female child.

Primary Tubercular Osteomyelitis Affecting the Mandibular Condyle - A Case Report

“…These are not pathognomonic and can be easily confused with arthritis, osteomyelitis, or a tumour. [ 4 6 ] and the same was observed in our case. The higher propensity of involvement of the posterior ramus and condyle is attributed to haematogenous dissemination owing to the vasculature of the medial pterygoid, masseter muscle from the inferior alveolar artery, and periosteal vessels.…”

“…The condition has been aptly named “master mimic” by many as it closely resembles other acute inflammatory conditions and tumours. [ 3 4 8 ] The culture requires 4–8-weeks and further 1–2-weeks turnover time for antibiotic sensitivity. Hence, the histopathological diagnosis is better considered to begin an appropriate therapy at an early stage of the disease.…”

“…[ 8 ] Surgical debridement of sequestrum, necrotic bone, and drainage of abscess along with ATT is the only surgical modality reported in the literature as performed in this case. [ 4 7 8 ]…”

“…Other local predisposing factors include poor oral hygiene and hyperkeratotic disorders such as leukoplakia. [ 3 4 ]…”