Orofacial tuberculous osteomyelitis: A case series emphasizing diagnostic challenges in atypical presentations

Objectives: To highlight atypical clinical and radiographic presentations of orofacial tuberculous osteomyelitis and emphasize diagnostic strategies and treatment outcomes. Methods: Four patients with chronic orofacial lesions unresponsive to conventional therapy were evaluated using imaging, histopathology, Mantoux testing, and CB-NAAT analysis. Anti-tubercular therapy was initiated following definitive diagnosis and outcomes were monitored. Results: All patients demonstrated significant clinical and radiographic improvement following first-line anti-tubercular therapy. Advanced diagnostic tools enabled early confirmation even in smear-negative cases. Conclusions: Orofacial tuberculosis should be considered in persistent maxillofacial infections. Early utilization of molecular diagnostics facilitates prompt management and prevents long-term complications.