Unusual Behavior of a Posttraumatic Scar

Craniofacial Actinomycosis

Ritesh Panda, DNB; Vivek Kumar, MS, DNB; Shiv Shankar Saha, MS, MCh; Lalit Choudhary, MS, MCh; Anurag Pandey, MS, MCh


Wounds. 2017;29(1):E1-E4. 

In This Article

Abstract and Introduction


Actinomycosis is a chronic suppurative granulomatous infection most commonly involving the cervicofacial region. Clinical diagnosis is usually difficult, and fine-needle aspiration cytology or imaging studies are usually unhelpful in diagnosing actinomycosis. Definitive diagnosis is based on the histopathological examination of a tissue biopsy. The authors report a case of a 32-year-old healthy man who underwent multiple surgeries over a period of 7 years to correct a posttraumatic scar on his forehead with unusual behavior. Final diagnosis was made by tissue biopsy. Scar was excised and penicillin was administered for 1 month postoperatively; after a 12-month follow-up, the wound was fully healed with minimal scarring and no recurrence.


Scar formation is an inevitable consequence of wound healing. Although desired by both the patient and surgeon, an unnoticeable scar is not always achievable due to certain interferences in wound healing that lead to disfiguring scars such as ischemia, infection, foreign bodies, steroids, diabetes, smoking, etc. After excluding these aforementioned conditions and ensuring optimal surgical technique, the surgeon must consider other diagnoses if the scar does not mature naturally. The authors report a case of a 32-year-old healthy man who underwent multiple surgeries over a 7-year period to correct a scar from a road traffic accident over his forehead with multiple discharging sinuses, which lowered the patient's self-esteem. Definitive diagnosis of actinomycosis was made by tissue biopsy after ruling out medical and hereditary conditions. He required both surgical and medical treatments for actinomycosis, and after a 12-month postoperative follow-up, the wound was well settled with no recurrence, thereby alleviating the patient's poor self-esteem due to his scar.