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Osteomyelitis attributable to Actinomyces often results in recurrent disease and inconsistent responses to antimicrobial agents. We present data for 4 patients and a review of the 15 previously described pediatric cases of actinomycosis presenting as osteomyelitis. Fourteen cases involved the mandible and 5 cases involved other sites. All mandibular cases required at least 1 debridement, with 4 of the cases requiring multiple debridements.