Maxillofacial tubercular osteomyelitis: diagnostic and therapeutic perspectives from a case series.

INTRODUCTION: Extrapulmonary tuberculosis (TB) contributes significantly to the disease burden in Southeast Asia, yet maxillofacial involvement is rare and often misdiagnosed due to nonspecific features such as swelling, ulceration, or trismus. Conventional microbiology shows low sensitivity in these paucibacillary lesions, emphasizing the role of rapid molecular tests such as Cartridge-Based Nucleic Acid Amplification Testing (CBNAAT). This case series outlines the diagnostic challenges of maxillofacial TB in an endemic region. Nine patients (aged 9-33 years) presented with chronic lesions in maxillofacial region. Imaging commonly demonstrated osteolysis, cortical breach, periosteal reaction, or soft-tissue abscess. Mantoux testing, cytology, and Ziehl-Neelsen staining were often inconclusive, whereas CBNAAT or culture confirmed Mycobacterium tuberculosis in most cases. All patients received standard anti-tubercular therapy with significant clinical and radiographic improvement.

CONCLUSION: Maxillofacial TB should be considered in persistent jaw lesions. Early molecular testing enhances diagnosis and supports timely, effective therapy.