A Clinicopathologic Review of 21 Cases of Head and Neck Primary Tuberculosis

J Oral Maxillofac Surg. 2020 Jun 14;S0278-2391(20)30576-0. doi: 10.1016/j.joms.2020.05.048. Online ahead of print.

Abstract

Purpose: A diagnosis of tuberculosis (TB) of the head and neck has been a dilemma for clinicians, because the clinical and pathologic features tend to mimic different pathologies. Our study aimed to identify the demographic, clinical, and pathologic features of head and neck TB to help healthcare providers in the early detection of the disease.

Materials and methods: We performed a retrospective analysis using the medical archives at the pathology laboratory. Twenty-one patients with a clinical and pathologic diagnosis of head and neck TB were identified from 2010 to 2019.

Results: The age distribution was broad, with 28.5% of the patients younger than 15 years old. Seven patients had oral TB, with the most common sites affected the labial vestibule (3 cases) and buccal vestibule (3 cases), followed by 1 case in the tongue. The predominant clinical presentation was ulceration, and the most common entity in the clinical differential diagnosis was squamous cell carcinoma. The most common histopathologic pattern of oral TB was a noncaseating granuloma. Most of the tuberculous lymphadenitis was located in the submandibular and submental areas.

Conclusions: TB of the head and neck region is not, as previously thought, a rare condition. Head and neck TB, in general, and oral TB, in particular, are great mimickers of different pathologic entities. In particular, the absence of the typical histopathologic pattern of TB granuloma has made the diagnosis more complicated. Healthcare providers must be vigilant and consider all the demographic, clinical, and histopathologic features to detect the disease earlier, because an early diagnosis can result in better outcomes.