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Pediatric Cervicofacial Actinomycosis

Lessons From a Craniofacial Unit

Glass, Graeme E. PhD, FRCS(Plast)*,†; Staruch, Robert M.T. MBBS, MRCS; Bradshaw, Karen MRCP, FRCR†,§; Charles, Adrian K. FRCP, FRC(Path)†,||; Stotland, Mitchell A. MD, FRSCS*,†

doi: 10.1097/SCS.0000000000005729
Clinical Studies

Actinomycosis is a rare disease that remains difficult to diagnose and manage. Prompted by 2 recent cases the authors sought evidence-based conclusions about best practice. A systematic review was conducted using standard PRISMA methodology. The study was registered prospectively (PROSPERO: CRD42018115064). Thirty-three children from 23 series are described. The mean age was 8 years (range 3–17). Fifty-five percent were female. Twenty cases involved bone (usually mandible); 13 cases involved cervicofacial soft tissue. Poor dental hygiene and oral trauma were implicated. The median diagnostic delay was 12 weeks (range 1–156 weeks). The median duration of definitive antibiotic therapy was 17 weeks (range 1–130 weeks). Although diagnostic delay did not correlate with number of surgeries, bony involvement was associated with more procedures (P = 0.008, unpaired t test). All (6) cases with residual infection had bony involvement (P = 0.06, Fisher exact test). Neither diagnostic delay nor number of surgeries significantly influenced infection-free outcome which, instead, relies on aggressive surgical debridement and prolonged antibiotic therapy. Mandibular involvement exhibits a higher surgical burden and chronicity in around a third of cases. As dental caries are implicated in mandibular disease, preventative strategies must focus on improving pediatric oral hygiene.

*Department of Surgery, Sidra Medicine, Doha, Qatar

Weill-Cornell Medical College, Ar-Rayyan, Qatar

Pan Thames Plastic Surgery Residency, London, UK

§Department of Radiology, Sidra Medicine, Doha, Qatar

||Department of Pathology, Sidra Medicine, Doha, Qatar.

Address correspondence and reprint requests to Graeme E. Glass, PhD, FRCS(Plast), Room C1-120, 1st Floor OPC, Al Luqta Street, Education City North Campus, Qatar Foundation, PO BOX 26999, Doha, Qatar; E-mail:

Received 5 March, 2019

Accepted 25 April, 2019

The authors report no conflicts of interest.

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© 2019 by Mutaz B. Habal, MD.