Primary Mandibular Tuberculous Osteomyelitis Mimicking Ameloblastoma: A Case Report and Literature Review of Mandibular Tuberculous Osteomyelitis

Abstract

Primary tuberculous osteomyelitis involving the mandible represents less than 2% of skeletal locations. In this paper, we report a case of mandibular tuberculosis (TB) detected after histopathological analysis of the surgically resected specimen during surgical management of a suspected case of ameloblastoma. A 14-year-old male patient presented to us with history of right-sided chin swelling. The clinical examination revealed a swelling, involving right body and parasymphysis of mandible, measuring approximately 6 cm in length and 2 cm in width, extending from right lateral incisor till the first molar. Radiological scans revealed a large multiloculated osteolytic expansive lesion measuring 52 × 20 × 18 mm. Excision of the lesion was performed and reconstruction was done with iliac bone grafting. The histopathological findings revealed a granulomatous lesion, suggestive of tuberculous osteomyelitis. The patient was successfully treated with standard multidrug therapy. One year after completion of therapy, there were no signs of recurrence. Primary mandibular TB is an extremely rare entity. Its clinical presentation is not specific. Radiologically, TB has no characteristic appearance. The positive diagnosis is based on histology. Primary mandibular TB is rare and should be kept among differential diagnoses in susceptible population and in endemic areas.

Keywords

mandible - osteomyelitis - tuberculosis

Authors' Contributions

Conceptualization: C.C. and A.K. Methodology: C.C., A.K. and K.B. Writing - original draft: A.K., K.B. and R.M. Writing - review & editing: C.C., A.K., K.B. and R.M.

Ethical Approval

Ethics and IRB approval not available in the institute where the surgery was performed.

Patient Consent

Informed consent was taken from the patient and his father for publication.

Publication History

Received: 02 April 2023

Accepted: 08 November 2023

Accepted Manuscript online:
25 November 2023

Article published online:
29 February 2024

• References

• 1 Imamura M, Kakihara T, Yamamoto K, Imai C, Tanaka A, Uchiyama M. Primary tuberculous osteomyelitis of the mandible. Pediatr Int 2004; 46 (06) 736-739
• 2 Kamath AT, Radhakrishnan R, Bhagania M, Mohan A. Tuberculous osteomyelitis of the mandible. J Maxillofac Oral Surg 2015; 14 (Suppl. 01) 200-202
• 3 Upadhyay S, Sharma A, Tuljapurkar V, Dabholkar JP. Primary tuberculous osteomyelitis of the mandible mimicking a parotid fistula. Rev Bras Otorrinolaringol (Engl Ed) 2011; 77 (03) 403
• 4 Saurabh S, Mall B, Somani R, Mishra A. Tuberculous osteomyelitis of the mandible: a rare case report. J Indian Acad Oral Med Radiol 2014; 26 (04) 439
• 5 World Health Organization. Tuberculosis. World Health Organization. Published October 27, 2022. https://www.who.int/news-room/fact-sheets/detail/tuberculosis [Accessed on October 03, 2023]
• 6 Elzouiti Z, Elayoubi F, Tsen AE. Mandibular tuberculosis fortuitously discovered after surgical resection of an ameloblastoma: a case report. Int J Surg Case Rep 2021; 87: 106399
• 7 Andrade NN, Mhatre TS. Orofacial tuberculosis–a 16-year experience with 46 cases. J Oral Maxillofac Surg 2012; 70 (01) e12-e22
• 8 Sheikh S, Pallagatti S, Gupta D, Mittal A. Tuberculous osteomyelitis of mandibular condyle: a diagnostic dilemma. Dentomaxillofac Radiol 2012; 41 (02) 169-174
• 9 American Thoracic Society, CDC, Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep 2003; 52 (RR-11): 1-77 [published correction appears in MMWR Recomm Rep. 2005 Jan 7;53(51):1203. Dosage error in article text]
• 10 Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A. SCARE Group. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg 2020; 84: 226-230
• 11 Torres-Lagares D, Infante-Cossío P, Hernández-Guisado JM, Gutiérrez-Pérez JL. Mandibular ameloblastoma. A review of the literature and presentation of six cases. Med Oral Patol Oral Cir Bucal 2005; 10 (03) 231-238
• 12 Vickers RA, Gorlin RJ. Ameloblastoma: delineation of early histopathologic features of neoplasia. Cancer 1970; 26 (03) 699-710
• 13 Ramesh Wadde K, Alam N, Chapane A. Tubercular osteomyelitis of the jaw - 2 case report. J Oral Med Oral Surg Oral Pathol Oral Radiol 2019; 5 (03) 85-87
• 14 Sambyal SS, Dinkar AD, Jayam C, Singh BP. Primary tuberculous osteomyelitis of the mandible in a 3-year-old child. BMJ Case Rep 2016; 2016: bcr2016216854
• 15 Karjodkar F, Saxena VS, Maideo A, Sontakke S. Osteomyelitis affecting mandible in tuberculosis patients. J Clin Exp Dent 2012; 4 (01) e72-e76
• 16 Dinkar AD, Prabhudessai V. Primary tuberculous osteomyelitis of the mandible: a case report. Dentomaxillofac Radiol 2008; 37 (07) 415-420
• 17 Worsaae N, Reibel J, Rechnitzer C. Tuberculous osteomyelitis of the mandible. Br J Oral Maxillofac Surg 1984; 22 (02) 93-98
• 18 Gupta KB, Manchanda M, Yadav SPS, Mittal A. Tubercular osteomyelitis of mandible. Indian J Tuberc 2005; 52: 147-150
• 19 Training Modules for Programme Managers and Medical Officers (NTEP). Central TB Division. Accessed at: tbcindia.gov.in https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=5465&lid=3540 [Accessed on October 03, 2023]
• 20 Nwoku LA, Kekere-Ekun TA, Sawyer DR, Olude OO. Primary tuberculous osteomyelitis of the mandible. J Maxillofac Surg 1983; 11 (01) 46-48
• 21 Sepheriadou-Mavropoulou T, Yannoulopoulos A. Tuberculosis of the jaws. J Oral Maxillofac Surg 1986; 44 (02) 158-162
• 22 Fukuda J, Shingo Y, Miyako H. Primary tuberculous osteomyelitis of the mandible. A case report. Oral Surg Oral Med Oral Pathol 1992; 73 (03) 278-280
• 23 Soman D, Davies SJ. A suspected case of tuberculosis of the temporomandibular joint. Br Dent J 2003; 194 (01) 23-24
• 24 Modali U, Kannan R, Rajasekaran ST, Raman U, Joshua E. Primary tuberculous osteomyelitis of the mandible. Asian J Oral Maxillofac Surg 2003; 15 (03) 208-213
• 25 Helbling CA, Lieger O, Smolka W, Iizuka T, Kuttenberger J. Primary tuberculosis of the TMJ: presentation of a case and literature review. Int J Oral Maxillofac Implants 2010; 39 (08) 834-838
• 26 Kumar S, Kumar R, Singh M. Primary tubercular osteomyelitis of mandible: rare presentation of a common disease. Indian J Tuberc 2012; 59 (01) 36-38
• 27 Bai S, Sun CF. Tuberculous osteomyelitis of the mandible with diffuse swelling of the floor of the mouth: a case report. J Oral Maxillofac Surg 2014; 72 (04) 749.e1-749.e6
• 28 Koul PA, Khan UH, Jan RA, Shah TH, Bagdadi F, Shah S. Tubercular osteomyelitis of the mandible in a young female. Int J Mycobacteriol 2014; 3 (02) 155-157
• 29 Gupta A, Gautam A, Kumar A, Bhattacharya S, Yadav P. Not all primary osteolytic mandibular swelling is malignant. Natl J Integr Res Med 2016; 7 (01) 127-129
• 30 Dalmia D, Shah P, Pillai J. Primary tuberculous osteomyelitis of the mandible mimicking a parotid gland abscess. Indian J Otolaryngol Head Neck Surg 2016; 68 (02) 257-260
• 31 Towdur GN, Upasi AP, Veerabhadrappa UK, Rai K. A rare, unusual presentation of primary tuberculosis in the temporomandibular joint. J Oral Maxillofac Surg 2018; 76 (04) 806-811
• 32 Kalaiarasi R, Vijayakumar C, Archana R, Natarajan R. Pediatric primary tuberculous osteomyelitis of the mandible mimicking parotitis. Cureus 2018; 10 (01) e2071
• 33 Prashant D, Prashant V. Tubercular osteomyelitis of jaw: a rare case report. Int J Med Res Rev 2022; 10 (06) 166-170
• 34 Gupta AA, Jadhav AA, Bhola ND, Mishra AS, Simre SS. Primary tubercular osteomyelitis affecting the mandibular condyle - a case report. Ann Maxillofac Surg 2022; 12 (01) 106-109