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Background <p>Actinomycosis is a chronic suppurative infection caused by anaerobic Actinomyces species that frequently mimics malignancy in the post-surgical setting of head and neck oncology. In patients who have undergone resection and reconstruction, the infection can present with progressive bone erosion and soft-tissue thickening on imaging, closely resembling tumour recurrence and posing a significant diagnostic pitfall. Early differentiation from malignancy is critical to avoid unnecessary morbid re-resections and to allow prompt initiation of targeted antimicrobial therapy.</p> Case Presentation <p>A 48-year-old male tobacco chewer with pT2N0M0 squamous cell carcinoma of the lower lip underwent wide local excision with commissure preservation, left supraomohyoid neck dissection, and reconstruction with a left nasolabial flap. Initial healing was satisfactory apart from a brief episode of Staphylococcus epidermidis infection on postoperative day 8 that resolved with antibiotics. Six months later he presented with facial pain and a single cutaneous fistula over the left mandibular body. Contrast-enhanced CT demonstrated irregular soft-tissue thickening and extensive erosive destruction of the left hemimandible, strongly suggestive of recurrent disease. However, the absence of regional lymphadenopathy or mucosal breach created clinical-radiological discordance. A Tru-Cut biopsy was performed; histopathology revealed characteristic actinomycotic granules with the Splendore-Hoeppli phenomenon, confirming cervicofacial actinomycosis. The patient was managed conservatively with oral Penicillin G (400,000 units QID for 6 months), resulting in complete clinical resolution, healthy granulation tissue formation, and avoidance of surgical debridement.</p> Conclusion <p>Postoperative mandibular actinomycosis can closely mimic tumour recurrence on imaging yet respond dramatically to prolonged antibiotic therapy. This case underscores the importance of maintaining a high index of suspicion and adhering to the principle of “re-biopsy before re-resection” whenever clinical and radiological findings are discordant. Histopathological confirmation remains essential to prevent unnecessary morbidity and ensure optimal, non-surgical management in such diagnostic dilemmas.</p>

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Post-Surgical Mandibular Actinomycosis Mimicking Tumor Recurrence: A Diagnostic Pitfall in Head and Neck Oncology

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Arjun Mahajan,
  • Dency Hansalia,
  • Mridula Shukla,
  • Manoj Pandey

摘要

Background

Actinomycosis is a chronic suppurative infection caused by anaerobic Actinomyces species that frequently mimics malignancy in the post-surgical setting of head and neck oncology. In patients who have undergone resection and reconstruction, the infection can present with progressive bone erosion and soft-tissue thickening on imaging, closely resembling tumour recurrence and posing a significant diagnostic pitfall. Early differentiation from malignancy is critical to avoid unnecessary morbid re-resections and to allow prompt initiation of targeted antimicrobial therapy.

Case Presentation

A 48-year-old male tobacco chewer with pT2N0M0 squamous cell carcinoma of the lower lip underwent wide local excision with commissure preservation, left supraomohyoid neck dissection, and reconstruction with a left nasolabial flap. Initial healing was satisfactory apart from a brief episode of Staphylococcus epidermidis infection on postoperative day 8 that resolved with antibiotics. Six months later he presented with facial pain and a single cutaneous fistula over the left mandibular body. Contrast-enhanced CT demonstrated irregular soft-tissue thickening and extensive erosive destruction of the left hemimandible, strongly suggestive of recurrent disease. However, the absence of regional lymphadenopathy or mucosal breach created clinical-radiological discordance. A Tru-Cut biopsy was performed; histopathology revealed characteristic actinomycotic granules with the Splendore-Hoeppli phenomenon, confirming cervicofacial actinomycosis. The patient was managed conservatively with oral Penicillin G (400,000 units QID for 6 months), resulting in complete clinical resolution, healthy granulation tissue formation, and avoidance of surgical debridement.

Conclusion

Postoperative mandibular actinomycosis can closely mimic tumour recurrence on imaging yet respond dramatically to prolonged antibiotic therapy. This case underscores the importance of maintaining a high index of suspicion and adhering to the principle of “re-biopsy before re-resection” whenever clinical and radiological findings are discordant. Histopathological confirmation remains essential to prevent unnecessary morbidity and ensure optimal, non-surgical management in such diagnostic dilemmas.