Actinomyces: An Under Appreciated Cause of Postoperative Infection in Rhinoplasty

• Published in: The Laryngoscope 2023-11, Vol.133 (11), p.2948-2950
• Main Authors: Eitan, Dana N., Grunebaum, Lisa D., Howard, Brittany E.
• Format: Article
• Language: English
• Subjects: aesthetic surgery; Antibiotics; facial plastics; infection; Infections; reconstructive surgery; Rhinoplasty
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30639

Objective To discuss a case series of Actinomyces infection post‐rhinoplasty and review the literature for correct diagnosis and management. Study Design Case series with chart review. Methods Three cases are presented of patients with a history of recurrent infectious symptoms post revision rhinoplasty later being diagnosed as Actinomyces. Results Three patients were identified having undergone revision rhinoplasty and later being diagnosed with Actinomyces infection. They initially presented with underwhelming physical exams, mild erythema, slight swelling, yet extreme pain. They also had periods of recurrent infection once antibiotics were stopped. Aerobic, anaerobic, fungal, and Actinomyces cultures were sent to pathology and returned positive for Actinomyces. Treatment typically involved a combination of prolonged antibiotics, incision and drainage, and/or surgical debridement. Conclusions Awareness of Actinomyces as a possible cause of infection post‐rhinoplasty is significant as this pathogen can lead to extensive tissue destruction and fistula formation which could be detrimental for a rhinoplasty. Duration of treatment is beyond typical lengths for other infections and a specific culture for Actinomyces is required to be sent as it isn't captured in standard aerobic/anaerobic cultures. Therefore, a high index of suspicion is required by physicians to ensure that patients are evaluated thoroughly. Laryngoscope, 133:2948–2950, 2023 Actinomyces infection postoperatively in a rhinoplasty patient has only be reported once previously in the literature. However, Actinomyces infection may be more common than its rare description would suggest; we present three cases of Actinomyces infection post‐rhinoplasty. A high index of suspicion for Actinomyces infection must be maintained as it is difficult to culture, requires prolonged treatment with antibiotics, and untreated can cause tissue loss with fistulization.