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Kim HY, Jung YS, Park W, Choi YJ, Kim JY. Can medication-related osteonecrosis of the jaw be attributed to specific microorganisms through oral microbiota analyses? A preliminary study. BMC Oral Health 2024; 24:160. [PMID: 38302952 PMCID: PMC10832156 DOI: 10.1186/s12903-024-03945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) can cause significant pain and loss of aesthetics and function if not treated properly. However, diagnosis still relies on detailed intraoral examinations and imaging. Prognosis varies even among patients with similar stages or conditions of MRONJ, emphasizing the need for a deeper understanding of its complex mechanisms. Thus, this study aimed to identify the oral microbiota of patients with MRONJ. METHODS This single-center prospective cohort study included patients with confirmed MRONJ who visited the Department of Oral and Maxillofacial Surgery at Yonsei University Dental Hospital between 2021 and 2022. Oral swab samples were collected from the affected and unaffected sides of each patient. The composition and enumeration of the microbial communities were analyzed, and the diversity was compared to verify ecological changes in the groups using a next-generation sequencing-based 16S metagenomic analysis. A statistical analysis was performed using Wilcoxon signed-rank test with SPSS version 22, and values of P less than 0.05 were considered statistically significant. RESULTS The final study sample included 12 patients. The mean age was 82.67 ± 5.73 (range, 72-90) years. Changes in microbial composition were observed at different taxonomic levels (phylum, genus, and species). The identified microorganisms were commonly associated with periodontitis, gingival disease, and endodontic infection, suggesting a multifactorial etiology of MRONJ. CONCLUSIONS Although this study is based on a small number of cases, it shows that MRONJ is not caused by a specific microorganism but can rather be caused by a variety of factors. By addressing these findings in large-scale studies, the significance of oral microbiome in pathogenesis can be further elucidated and can facilitate the development of effective therapeutic interventions for patients with MRONJ.
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Affiliation(s)
- Heon-Young Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Centre, Seoul, Republic of Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Wonse Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Yoon Jeong Choi
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jun-Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea.
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2
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Halpern LR, Adams DR. Treatment of Medication-Related Osteonecrosis of the Jaw: Controversies in Causality and Therapy. Dent Clin North Am 2024; 68:67-85. [PMID: 37951638 DOI: 10.1016/j.cden.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a most interesting, complex and "elusive" condition seen by the oral health care provider. It is plagued by controversy and although a wealth of research has created clinical treatment databases, there is no "gold standard" algorithm to be applied in a universal fashion. The purpose of this article is to explore several controversies associated with the etiology(s), staging, treatments, and long-term resolution of MRONJ in patients who are treated by the oral health care provider. Controversies for optimizing prevention, and disease control will also be discussed from an interdisciplinary perspective.
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Affiliation(s)
- Leslie Robin Halpern
- New York Medical College/NYCHHC, Metropolitan Hospital, 100 Woods Road, Valhalla, NY 10593, USA.
| | - David Russell Adams
- Section head, Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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3
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Kang YH, Lee SS, Aung MTZ, Kang JH, Kim JE, Huh KH, Heo MS. Mucormycosis-related osteomyelitis of the maxilla in a post-COVID-19 patient. Imaging Sci Dent 2022; 52:435-440. [PMID: 36605866 PMCID: PMC9807792 DOI: 10.5624/isd.20220143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 12/28/2022] Open
Abstract
Mucormycosis is a rare, invasive fungal infection that progresses aggressively and requires prompt surgery and appropriate treatment. The number of cases of mucormycosis in coronavirus disease 2019 (COVID-19) patients has recently increased, and patients with uncontrolled diabetes mellitus are particularly at an elevated risk of infection. This report presents a case of mucormycosis-related osteomyelitis of the maxilla in a 37-year-old man with diabetes mellitus. The patient complained of severe and persistent pain in the right maxilla, accompanied by increased tooth mobility and headache. On contrast-enhanced computed tomographic images, gas-forming osteomyelitis of the right maxilla was observed. Destruction of the maxilla and palatine bone then proceeded aggressively. Sequestrectomy was performed on the right maxilla, and the histopathological diagnosis was mucormycosis. Further investigation after the first operation revealed the patient's history of COVID-19 infection.
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Affiliation(s)
- Yun-Hui Kang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Moe Thu Zar Aung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea.,Department of Oral Medicine, University of Dental Medicine, Mandalay, Myanmar
| | - Ju-Hee Kang
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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4
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Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg 2022; 80:920-943. [PMID: 35300956 DOI: 10.1016/j.joms.2022.02.008] [Citation(s) in RCA: 313] [Impact Index Per Article: 156.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022]
Abstract
Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaws (MRONJ) - formerly referred to as bisphosphonate-related osteonecrosis of the jaws (BRONJ)-were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007, 2009 and 2014. The position papers were developed by a committee appointed by the AAOMS Board of Trustees and comprising clinicians with extensive experience in caring for these patients, as well as clinical and basic science researchers. The knowledge base and experience in addressing MRONJ continues to evolve and expand, necessitating modifications and refinements to the previous position papers. Three members of the AAOMS Committee on Oral, Head, and Neck Oncologic and Reconstructive Surgery (COHNORS) and three authors of the 2014 position paper were appointed to serve as a working group to analyze the current literature and revise the guidance as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis and management strategies and highlights the current research status. AAOMS maintains that it is vitally important for this information to be disseminated to other relevant healthcare professionals and organizations.
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Affiliation(s)
- Salvatore L Ruggiero
- Clinical Professor, Division of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Hofstra North Shore-LIJ School of Medicine, New York Center for Orthognathic and Maxillofacial Surgery, Lake Success, NY.
| | - Thomas B Dodson
- Professor and Chair, University of Washington School of Dentistry, Department of Oral and Maxillofacial Surgery, Seattle, Wash
| | - Tara Aghaloo
- Professor, Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, Calif
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Endowed Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Brent B Ward
- Chalmers J Lyons Professor of Oral and Maxillofacial Surgery, Associate Professor of Dentistry, Chair of the Department of Oral and Maxillofacial Surgery/Hospital Dentistry in the School of Dentistry and Associate Professor of Surgery for the Medical School, University of Michigan Hospital, Ann Arbor, Mich
| | - Deepak Kademani
- Chief of Staff North Memorial Health, Fellowship Director, Oral/Head and Neck Oncologic and Reconstructive Surgery Attending Surgeon, North Memorial Health and the University of Minnesota. Private practice, Minnesota Oral and Facial Surgery and Minnesota Head and Neck Surgery, Minneapolis, Minn
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5
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Upadhyay S, Bharara T, Khandait M, Chawdhry A, Sharma BB. Mucormycosis – resurgence of a deadly opportunist during COVID-19 pandemic: Four case reports. World J Clin Cases 2021; 9:11338-11345. [PMID: 35071564 PMCID: PMC8717511 DOI: 10.12998/wjcc.v9.i36.11338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/06/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) patients who suffer severe infection or comorbidities have an increased risk of developing fungal infections. There is a possibility that such infections are missed or misdiagnosed, in which case patients may suffer higher morbidity and mortality. COVID-19 infection, aggressive management strategies and comorbidities like diabetes render patients prone to opportunistic fungal infections. Mucormycosis is one of the opportunistic fungal infections that may affect treated COVID patients.
CASE SUMMARY We present a case series of four adult males who were diagnosed with mucormycosis post-COVID-19 recovery. All the patients had diabetes and a history of systemic corticosteroids for treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.5 ± 14.5 (7–30) d. All patients underwent debridement and were started on antifungal therapy. One patient was referred to a higher center for further management, but the others responded well to treatment and showed signs of improvement at the last follow-up.
CONCLUSION Early diagnosis and management of mucormycosis with appropriate and aggressive antifungals and surgical debridement can improve survival.
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Affiliation(s)
- Shalini Upadhyay
- Department ofMicrobiology, SGT University, Gurugram 122505, Haryana, India
| | - Tanisha Bharara
- Department ofMicrobiology, SGT University, Gurugram 122505, Haryana, India
| | - Manisha Khandait
- Department ofMicrobiology, SGT University, Gurugram 122505, Haryana, India
| | - Ankit Chawdhry
- Department of Oral and Maxillofacial Surgery, SGT University, Gurugram 122505, Haryana, India
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6
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Palou EY, Ramos MA, Cherenfant E, Duarte A, Fuentes-Barahona IC, Zambrano LI, Muñoz-Lara F, Montoya-Ramirez SA, Cardona-Ortiz AF, Valle-Reconco JA, Montenegro-Idrogo JJ, Bonilla-Aldana DK, Paniz-Mondolfi AE, Rodriguez-Morales AJ. COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis-A Case Report from Honduras. Vaccines (Basel) 2021; 9:826. [PMID: 34451951 PMCID: PMC8402527 DOI: 10.3390/vaccines9080826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. CASE A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. CONCLUSIONS Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.
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Affiliation(s)
- Elsa Yolanda Palou
- Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (E.Y.P.); (F.M.-L.)
| | | | - Emec Cherenfant
- Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Adoni Duarte
- Department of Morphological Sciences, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Itzel Carolina Fuentes-Barahona
- Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
- Department of Gynecology and Obstetrics, Hospital Escuela, Tegucigalpa 11101, Honduras
| | - Lysien I. Zambrano
- Unit of Scientific Research (UIC), Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
| | - Fausto Muñoz-Lara
- Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras; (E.Y.P.); (F.M.-L.)
- Department of Internal Medicine, Hospital Escuela, Tegucigalpa 11101, Honduras;
| | | | - Alex Francisco Cardona-Ortiz
- Post-Graduate Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Jorge Alberto Valle-Reconco
- Deanship, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras;
| | - Juan J. Montenegro-Idrogo
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima 15046, Peru
- Infectious and Tropical Diseases Service, Hospital Nacional Dos de Mayo, Lima 15072, Peru
| | - D. Katterine Bonilla-Aldana
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Semillero de Investigación en Zoonosis (SIZOO), Grupo de Investigación GISCA, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira 660003, Colombia
| | - Alberto E. Paniz-Mondolfi
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Laboratory of Microbiology, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Instituto de Investigaciones Biomédicas IDB/Incubadora Venezolana de la Ciencia, Barquisimeto 3001, Venezuela
| | - Alfonso J. Rodriguez-Morales
- Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia; (J.J.M.-I.); (D.K.B.-A.); (A.E.P.-M.)
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Risaralda 660003, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15046, Peru
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7
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Vasilyeva D, Lee KC, Alex G, Peters SM. Painful palatal lesion in a 90-year-old female. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:626-630. [PMID: 33032939 DOI: 10.1016/j.oooo.2020.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Daria Vasilyeva
- Resident, Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - Kevin C Lee
- Resident, Department of Oral and Maxillofacial Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - Scott M Peters
- Assistant Professor, Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA.
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8
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Manji F, Lam JC, Meatherall BL, Church D, Missaghi B. Severe facial necrosis in a type 1 diabetic patient secondary to mucormycosis masquerading as an internal maxillary artery occlusion: a case report. BMC Infect Dis 2019; 19:184. [PMID: 30795757 PMCID: PMC6387511 DOI: 10.1186/s12879-019-3822-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mucormycosis is a group of rare but life threatening angioinvasive infections caused by fungi of the order Mucorales that often occurs in immunocompromised patients and individuals with poorly controlled diabetes. Rhinocerebral mucormycosis can mimic sinusitis but can rapidly progress to deeper disease and cause facial necrosis. Facial vascular thrombosis is a rare complication of mucormycosis and can confound diagnosis of the disease. CASE PRESENTATION We report the case of a 25-year-old female with poorly controlled type 1 diabetes mellitus who initially presented with symptoms of sinusitis but rapidly progressed with signs of left-sided facial necrosis due to occlusion of the left internal maxillary artery. Early surgical debridement did not yield a microbiological diagnosis. Deeper surgical debridements ultimately revealed angioinvasive fungal disease consistent with mucormycosis. The patient recovered after repeated surgical intervention and aggressive parenteral antifungal therapy. CONCLUSION This case illustrates an atypical complication of mucormycosis, and emphasizes that a high index of suspicion in vulnerable patient populations aids in the diagnosis of this life-threatening infection.
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Affiliation(s)
- Farheen Manji
- Alberta Health Services, Calgary, Canada. .,University of Calgary, Calgary, Canada.
| | - John C Lam
- Alberta Health Services, Calgary, Canada.,University of Calgary, Calgary, Canada
| | - Bonnie L Meatherall
- Alberta Health Services, Calgary, Canada.,University of Calgary, Calgary, Canada
| | | | - Bayan Missaghi
- Alberta Health Services, Calgary, Canada.,University of Calgary, Calgary, Canada
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9
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Ramadorai A, Ravi P, Narayanan V. Rhinocerebral Mucormycosis: A Prospective Analysis of an Effective Treatment Protocol. Ann Maxillofac Surg 2019; 9:192-196. [PMID: 31293952 PMCID: PMC6585200 DOI: 10.4103/ams.ams_231_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: The objective of this study was to prospectively analyze the effectiveness of a treatment protocol in patients diagnosed with rhinocerebral mucormycosis. Materials and Methods: This series included ten patients who reported with suspicious clinical signs of mucormycosis. The diagnosis was established by histopathology, and computed tomography imaging was used to assess the extent of spread. All patients were treated with immediate radical surgical debridement and antifungal chemotherapy with amphotericin B. Simultaneous correction of the underlying immunosuppressive condition was carried out. The primary outcome assessed was disease-free survival, and the patients were followed up for up to 6 months after discharge. Results: In this series, the cause of immunosuppression was uncontrolled diabetes mellitus in all patients. All the patients responded to the treatment protocol and were free of the disease up to 6 months of follow-up. Conclusion: Mucormycosis is an invasive and potentially fatal disease. Prognosis can be improved by early recognition and prompt treatment with aggressive resection, intravenous amphotericin B, and control of the patient's underlying systemic condition.
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Affiliation(s)
- Ashok Ramadorai
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Poornima Ravi
- Department of Oral and Maxillofacial Surgery, SRM Dental College, Chennai, Tamil Nadu, India
| | - Vinod Narayanan
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai, Tamil Nadu, India
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10
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Cheong HS, Kim SY, Ki HK, Kim JY, Lee MH. Oral mucormycosis in patients with haematologic malignancies in a bone marrow transplant unit. Mycoses 2017; 60:836-841. [DOI: 10.1111/myc.12678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/06/2017] [Accepted: 07/29/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Hae Suk Cheong
- Division of Infectious Disease; Konkuk University Medical Centre; Konkuk University School of Medicine; Seoul Korea
| | - Sung Yong Kim
- Division of Haematology-Oncology; Department of Internal Medicine; Konkuk University Medical Centre; Konkuk University School of Medicine; Seoul Korea
| | - Hyun Kyun Ki
- Division of Infectious Disease; Konkuk University Medical Centre; Konkuk University School of Medicine; Seoul Korea
| | - Jun Yeon Kim
- Department of Dentistry; Konkuk University Medical Centre; Konkuk University School of Medicine; Seoul Korea
| | - Mark Hong Lee
- Division of Haematology-Oncology; Department of Internal Medicine; Konkuk University Medical Centre; Konkuk University School of Medicine; Seoul Korea
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11
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Kalaskar RR, Kalaskar AR, Ganvir S. Oral mucormycosis in an 18-month-old child: a rare case report with a literature review. J Korean Assoc Oral Maxillofac Surg 2016; 42:105-10. [PMID: 27162751 PMCID: PMC4860375 DOI: 10.5125/jkaoms.2016.42.2.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/16/2022] Open
Abstract
Oral mucormycosis is a fungal infection observed mainly in elderly immunocompromised patients. In rare instances, the disease occurs in healthy individuals and those patients that are below preschool age. Although this condition mainly involves the maxilla, it may also manifest in any part of the oral cavity based on the source of infection. Mucormycosis of the maxilla spreads rapidly, leading to necrosis of the palatal bone and palatal perforation. Such patients are usually rehabilitated using bone grafting or free flap surgeries. However, when surgeries are delayed, palatal prosthesis is an interim treatment modality that can prevent nasal regurgitation and aspiration of food or fluids. Palatal prostheses also help with mastication, speech, and swallowing. The present case describes a rare case of oral mucormycosis in an 18-month-old male involving the maxilla that was managed by palatal prosthesis.
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Affiliation(s)
- Ritesh Rambharos Kalaskar
- Department of Pedodontic & Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Ashita Ritesh Kalaskar
- Department of Oral Diagnosis Medicine & Radiology, VSPM Dental College & Research Centre, Nagpur, India
| | - Sindhu Ganvir
- Department of Oral Pathology & Microbiology, Government Dental College & Hospital, Nagpur, India
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12
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Mandibular Bone Exposure and Osteonecrosis in a Patient With an Uncomplicated Medical History. J Craniofac Surg 2015; 26:1719-20. [PMID: 26107001 DOI: 10.1097/scs.0000000000001775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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13
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Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res 2015; 30:3-23. [PMID: 25414052 DOI: 10.1002/jbmr.2405] [Citation(s) in RCA: 827] [Impact Index Per Article: 91.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 11/08/2022]
Abstract
This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.
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Deepa AG, Nair BJ, Sivakumar TT, Joseph AP. Uncommon opportunistic fungal infections of oral cavity: A review. J Oral Maxillofac Pathol 2014; 18:235-43. [PMID: 25328305 PMCID: PMC4196293 DOI: 10.4103/0973-029x.140765] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/04/2014] [Indexed: 12/17/2022] Open
Abstract
The majority of opportunistic oral mucosal fungal infections are due to Candida albicans and Aspergillus fumigatus species. Mucor and Cryptococcus also have a major role in causing oral infections, whereas Geotrichum, Fusarium, Rhodotorula, Saccharomyces and Penicillium marneffei are uncommon pathogens in the oral cavity. The broad spectrum of clinical presentation includes pseudo-membranes, abscesses, ulcers, pustules and extensive tissue necrosis involving bone. This review discusses various uncommon opportunistic fungal infections affecting the oral cavity including their morphology, clinical features and diagnostic methods.
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Affiliation(s)
- AG Deepa
- Department of Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Vattappara, Thiruvananthapuram, Kerala, India
| | - Bindu J Nair
- Department of Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Vattappara, Thiruvananthapuram, Kerala, India
| | - TT Sivakumar
- Department of Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Vattappara, Thiruvananthapuram, Kerala, India
| | - Anna P Joseph
- Department of Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Vattappara, Thiruvananthapuram, Kerala, India
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Magremanne M, Picheca S, Reychler H. [Etiologic diagnosis of jaw osteonecrosis, other than bisphosphonate and radiotherapy related osteitis]. REVUE DE STOMATOLOGIE, DE CHIRURGIE MAXILLO-FACIALE ET DE CHIRURGIE ORALE 2014; 115:e1-e7. [PMID: 24456912 DOI: 10.1016/j.revsto.2013.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/29/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
Our purpose was to highlight the various etiologies of maxillo-mandibular osteonecrosis, other than radiotherapy and biphosphonate related osteitis that have been abundantly reported. We performed a PubMed search from August 1, 1972 to August 1, 2012 using the following MeSH terms: "osteonecrosis", "bone", "necrosis", "jaw", "maxilla", "mandible", "palate", "oral", "avascular necrosis", NOT "bisphosphonate" NOT "osteoradionecrosis". Most cases of osteonecrosis were iatrogenic. Viral, mycotic, or bacterial infections were less frequent causes. Cocaine abuse, Wegener's granulomatosis, and N/K lymphoma were other etiologies. It is important to identify the various etiologies rapidly to manage this sometimes very mutilating condition adequately.
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Affiliation(s)
- M Magremanne
- Service de stomatologie et chirurgie maxillofaciale, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgique.
| | - S Picheca
- Service de stomatologie et chirurgie maxillofaciale, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - H Reychler
- Service de stomatologie et chirurgie maxillofaciale, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgique
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Magremanne M, Picheca S, Reychler H. Etiologic diagnosis of jaw osteonecrosis, other than bisphosphonate and radiotherapy related osteonecrosis. ACTA ACUST UNITED AC 2014; 115:45-50. [PMID: 24456913 DOI: 10.1016/j.revsto.2013.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/29/2013] [Accepted: 12/12/2013] [Indexed: 01/22/2023]
Abstract
Our purpose was to highlight the various etiologies of maxillo-mandibular osteonecrosis, other than radiotherapy and biphosphonate related osteitis that have been abundantly reported. We performed a PubMed search from August 1, 1972 to August 1, 2012 using the following MeSH terms: "osteonecrosis", "bone", "necrosis", "jaw", "maxilla", "mandible", "palate", "oral", "avascular necrosis", NOT "bisphosphonate" NOT "osteoradionecrosis". Most cases of osteonecrosis were iatrogenic. Viral, mycotic, or bacterial infections were less frequent causes. Cocaine abuse, Wegener's granulomatosis, and N/K lymphoma were other etiologies. It is important to identify the various etiologies rapidly to manage this sometimes very mutilating condition adequately.
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Affiliation(s)
- M Magremanne
- Service de stomatologie et chirurgie maxillofaciale, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgium.
| | - S Picheca
- Service de stomatologie et chirurgie maxillofaciale, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - H Reychler
- Service de stomatologie et chirurgie maxillofaciale, cliniques universitaires Saint-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgium
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Akhrass FA, Debiane L, Abdallah L, Best L, Mulanovich V, Rolston K, Kontoyiannis DP. Palatal mucormycosis in patients with hematologic malignancy and stem cell transplantation. Med Mycol 2011; 49:400-5. [DOI: 10.3109/13693786.2010.533391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Almazrooa SA, Chen K, Nascimben L, Woo SB, Treister N. Osteonecrosis of the Mandible After Laryngoscopy and Endotracheal Tube Placement. Anesth Analg 2010; 111:437-41. [DOI: 10.1213/ane.0b013e3181e0cdcd] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bonifaz A, Macias B, Paredes-Farrera F, Arias P, Ponce RM, Araiza J. Palatal zygomycosis: experience of 21 cases. Oral Dis 2008; 14:569-74. [DOI: 10.1111/j.1601-0825.2007.01433.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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