Scrofula and Other Tuberculous Infections of the Head and Neck

With improvement in economic and social conditions and the use of effective anti-tuberculous therapy, the developed nations and most developing nations have enjoyed a decline in tuberculosis (TB) for several decades. However, over ten million cases of TB are reported annually and TB continues to kill nearly two million people each year. Extrapulmonary TB comprises 15–30% of new TB cases, and tuberculous lymphadenitis is an important manifestation. Tuberculous cervical lymphadenitis, or scrofula, accounts for at least 70% of TB cases involving the head and neck. The majority of cases occur without systemic symptoms or concurrent pulmonary TB. In addition to cervical lymphadenitis, tuberculosis can produce isolated disease in the oral cavity, ear, salivary glands, mandible, nose, and larynx. These infections can have various manifestations and it is important for the clinician to recognize and diagnose head and neck TB promptly. This chapter reviews the epidemiology, clinical manifestations, diagnosis, and treatment of various tuberculous infections in the head and neck.