PMC4586902_01
Clinical photograph showing oroantral fistula.
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fig1
There were necrosis and purulent discharge (Figure 1).
OPG showing destructive radiolucent lesion of right maxilla.
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fig2
The OPG showed a destructive lesion involving palate (Figure 2).
Photomicrograph of smear (10x) Gram's staining image of actinomycotic colony with peripheral neutrophilic aggregation.
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fig3
There were clumps of tangled masses of elongated bacilli with peripheral neutrophilic aggregation (Figure 3).
Photomicrograph of smear (oil immersion). Tangled mass of Periodic acid-Schiff (PAS) positive branching filaments.
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fig4
The filaments were non-acid fast and were PAS (Periodic acid-Schiff stain) positive (Figure 4).
Photomicrograph of biopsy (10x) H&E oral epithelium with large actinomycotic colonies ( ).
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fig5
The incisional biopsy from the soft tissue and adjacent exposed necrotic bone revealed a stratified squamous epithelium with large clumps of basophilic bacterial colonies resembling actinomycotic colonies (Figure 5).
Photomicrograph (10x) of H&E decalcified section. Necrotic thickened bony trabeculae with Actinomyces filaments on trabecular surface of bony spicules ( ), with extensive sclerosis of bone showing prominent resting and reversal lines (  ).
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fig6
The necrotic bone showed sclerosis with actinomycotic colonies within bony sequestra and on trabecular surface (Figure 6).
Photomicrograph (10x) H&E section. Extensive fibrosis with granulomas and degeneration of salivary gland acini.
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fig7
There was extensive fibrosis with resolving granulomas and no bacterial colonies were observed (Figures 7 and 8).
Photomicrograph (40x) of H&E. Resolving granulomas with giant cells.
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fig8
There was extensive fibrosis with resolving granulomas and no bacterial colonies were observed (Figures 7 and 8).
Postoperative photograph after 2 months of follow-up.
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fig9
The patient was recalled after one month and showed improvement with resolution of the lesion (Figure 9).