•Jaw and salivary gland involvement is common
•Trismus is common
•Periapical inflammatory lesions may also occur
•Tongue, buccal mucosa, lips, gingiva, and tonsils are the most common oral sites involved
The clinical diagnosis should be confirmed by biopsy and histopathologic examination, direct microbiologic examination and culture, and indirect immunofluorescence.
•Periodontal abscess
•Dental abscess
•Tuberculosis
•Systemic mycoses
•Other infections
•Benign and malignant tumors
Basic Guidelines
•The response to treatment is slow.
•Treatment should be continued for weeks or months after clinical cure to avoid recurrences.
•The best therapeutic regimen includes a combination of drugs and surgery.
Suggested Therapies
•Intramuscular penicillin C. 10-20 Mil/day for 4-6 weeks, is the drug of choice for early cervicofacial actinomycosis. This regimen is usually followed by oral penicillin V 500 mg four times daily for I -3 months. Localized, limited disease usually responds well to a combination of surgical removal of the infected tissues and a 2-4-week course of penicillin.
•Tetracycline 500 mg three to four times daily for 2-4 months may be used as an alternative drug for patients allergic to penicillin.
•Intramuscular or intravenous ampicillin 50 mg/kg per day for 4-6 weeks, followed by oral amoxicillin 500 mg/day for 6-12 additional months should be given to prevent recurrences.
•Surgical procedures such as drainage and resection should be also carried out along with the drug therapy for better results.
Alternative Therapy
Sulfamethoxazole 2-4 g/day for 4-6 weeks or more is an alternative regimen.
References
Hirshberg A, Tsesis I, Metzger Z, Kaplan I. Periapical actinomycosis: A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:614–620.
Laskaris G. Oral manifestations of infectious diseases. Dent Clin North Am 1996;40:395–423.
Rahnama M, Tomaszewski T. Cervicofacial actinomycosis: An issue still present. Ann Univ Mariae Curie Sklodowska 2001;56:447–449.
Rush JR, Suite HR, Cohen DM, Makkawy H. Course of infection and case outcome in individuals diagnosed with microbial colonies morphologically consistent with Actinomyces species J Endod 2002;28:613–618.
Adenocarcinomas of the Salivary Glands
Salivary gland adenocarcinomas constitute a relatively rare group of oral malignancies originating from the epithelium of the major or minor salivary glands.
The etiology of adenocarcinomas of the salivary glands is unknown.
•Mucoepidermoid carcinoma
•Adenoid cystic carcinoma
•Malignant pleomorphic adenoma
•Acinic cell adenocarcinoma
•Clear cell adenocarcinoma
•Polymorphous low-grade adenocarcinoma
•Adenocarcinoma not otherwise specified
•Epithelial-myoepithelial carcinoma
•Other types
The box gives the clinical features of minor salivary gland malignant neoplasms only.
•Slow-growing, usually painless, rubbery swelling
•Tumor may be slightly mobile and may ulcerate later
•Size progressively increases and pain may develop during the late stages
•Soft palate, buccal mucosa, and upper lip are the most commonly affected sites
•Clinical features are not characteristic and diagnostic
The clinical diagnosis should be confirmed by biopsy and histopathologic examination.
•Different types of malignant salivary gland tumor
•Pleomorphic adenoma
•Monomorphic adenoma
•Mucocele
•Necrotizing sialadenometaplasia
•Non-Hodgkin lymphoma
•Malignant granuloma
•Squamous cell carcinoma
•Sarcomas
Basic Guidelines
•Before treatment a full clinical examination and laboratory investigations should be done.
•The treatment depends on the grade and stage of each tumor.
•A follow-up program is necessary as recurrences and metastasis are relatively common.
•Details of the surgical procedures are beyond the scope of this book.
Suggested Therapies
•Radical surgical excision is the treatment of choice in all types of malignant salivary gland neoplasms.
•Postoperative radiation therapy may also be used as adjuvant therapy in advanced and aggressive neoplasms.
References
Bensdoum RJ, Allavena C, Chauvel P, et al. 2003 update of standards, options and recommendations for radiotherapy for patients with salivary gland malignant tumors. Cancer Radiother 2003;7:280–295.
Brandwein MS, Ivanov K, Wallace DI, et al. Mucoepidermoid carcinoma: a clinicopalhologic study of 80 patients with special reference to histological grading. Am J Surg Pathol 2001;25:835–845.
Caccamese JF, Ord RA, Paediatric mucoepidermoid carcinoma of the palate, int J Oral Maxillofac Surg 2002;31:136–139.
Castle JT, Thompson LD, Frommelt RA, et al. Polymorphous low grade adenocarcinoma: a