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Li CX, Gong ZC, Pataer P, Shao B, Fang C. A retrospective analysis for the management of oromaxillofacial invasive mucormycosis and systematic literature review. BMC Oral Health 2023; 23:115. [PMID: 36810012 PMCID: PMC9942087 DOI: 10.1186/s12903-023-02823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Mucormycosis is a type of fatal infectious disease, rarely involved in the oromaxillofacial region. This study aimed to describe a series of 7 cases with oromaxillofacial mucormycosis and to discuss the epidemiology, clinical features, and treatment algorithm thereof. METHODOLOGY Seven patients in the author's affiliation have been treated. They were assessed and presented as per their diagnostic criteria, surgical approach, and mortality rates. Reported cases of mucormycosis originally happened in craniomaxillofacial region were synthesized through a systematic review so as to better discuss its pathogenesis, epidemiology, and management. RESULTS Six patients had a primary metabolic disorder, and one immunocompromised patient had a history of aplastic anemia. The criteria for a positive diagnosis of invasive mucormycosis were based on clinical presentation of signs and symptoms, and a biopsy for microbiological culture and histopathologic analysis. Each patient used antifungal drugs and five of them also underwent surgical resection at the same time. Four patients died due to the unregulated spread of mucormycosis, and one patient died owing to her main disease. CONCLUSIONS Although uncommon in clinical practice setting, mucormycosis should be of great concern in oral and maxillofacial surgery, due to the life-threatening possibility of this disease. The knowledge of early diagnosis and prompt treatment is of utmost importance for saving lives.
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Affiliation(s)
- Chen-xi Li
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China ,grid.33199.310000 0004 0368 7223Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022 People’s Republic of China
| | - Zhong-cheng Gong
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Parekejiang Pataer
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Bo Shao
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Chang Fang
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
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Almutairi F, Alsuwaydani Z, Thekkiniyakath Ali A, M. Alraqibah M, A. Alharbi B, A. Alyahya R, N. Alrudhayman S, Albisher R. Role of dentist: COVID19 and mucormycosis. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S2-S6. [PMID: 36110677 PMCID: PMC9469452 DOI: 10.4103/jpbs.jpbs_734_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Dental practice has evolved over time and has adapted to the challenges that it has faced. The risk of infection spread via droplet and airborne routes poses a significant risk to the dentist who works close to patients. The risk of cross-infection between dental health-care personnel and patients can be very high due to the peculiar arrangements of dental settings. Dental clinics should have air purification systems with high volume excavators and negative pressure rooms for COVID-19 screening. Mucormycosis is a fungal disease that mostly occurs in immunocompromised individuals and those with uncontrolled diabetes. Dental extraction can trigger the occurrence. Increased occurrence of mucormycosis is seen in COVID-affected patients. This article gives a review on the dentistry-related transmission of COVID 19, the relation of COVID and mucormycosis.
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Chaurasia A, Airan M, Mall S, Gupta S, Sharma H, Mohini A. Postanaesthetic Aseptic Palatal Necrosis - A Case Report. Ann Maxillofac Surg 2021; 11:173-175. [PMID: 34522678 PMCID: PMC8407628 DOI: 10.4103/ams.ams_289_20] [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: 08/20/2020] [Revised: 04/04/2021] [Accepted: 04/17/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: In dentistry, the most common procedure to be applied is administration of a local anaesthetic agent. It is impossible to practice dentistry without local anaesthesia. In the oral cavity, the palatal mucosa is tightly adherent to the palatal bone and there is little space for anaesthetic solution to be deposited. If local anaesthetic is forcefully injected by the syringe, it creates pressure on blood vessels and causes palatal necrosis. Patient Concern: Here, we present a case report of a 25-year-old male patient who reported to us with chief complaint of an ulcer on the palate. Diagnosis: Patient was diagnosed with postanaesthetic aseptic palatal necrosis. Intervention: The patient was managed conservatively using copious irrigation and a palatal acrylic splint. Outcome: On the 6th month follow-up, the lesion was completely replaced by healthy mucosa. Take-away Lessons: We should avoid forceful injection of local anaesthetic agent to prevent further postoperative complications.
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Affiliation(s)
- Archana Chaurasia
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Meenal Airan
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Sunil Mall
- Department of Oral and Maxillofacial Surgery, Mall Dental Clinic, Deoria, Uttar Pradesh, India
| | - Sakshi Gupta
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Himanshu Sharma
- Department of Oral and Maxillofacial Surgery, Advanced Dental Care and Implant Centre, Bareilly, Uttar Pradesh, India
| | - Anila Mohini
- Department of Oral Medicine and Radiology, Chitwan Medical College, Bharatpur, Nepal
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Ortega-Hidalgo BD, Monge K, Pérez V, Villanueva-Vilchis MDC, Gaitán-Cepeda LA. Non-neoplasic and non-syndromic palatal perforations. Presentation of 5 cases and systematic review of the literature. J Clin Exp Dent 2021; 13:e961-e968. [PMID: 34603627 PMCID: PMC8464392 DOI: 10.4317/jced.58714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Palatal perforations not associated with syndromes or neoplasms are rare lesions whose frequency has increased recently. However, their clinical and demographic characteristics have not been fully described. Therefore, this report aimed to establish the demographic and clinical characteristics of patients with non-syndromic and non-neoplastic palatal perforations. MATERIAL AND METHODS The file of an oral medicine teaching clinic from January 2004 to December 2018 was reviewed to identify and isolate all cases with a diagnosis of palatal perforation. Cases with a diagnosis of palatal perforation related to congenital alteration, syndrome, or neoplasia were excluded. Age, sex, medical history, and diagnosis were obtained from the clinical history. In addition, a systematic review of the literature was performed using a PICO strategy. MEDLINE electronic databases from January 1990 to December 2018 were systematically reviewed using the combination of keywords with Boolean terms "OR" (palatal perforation, destruction of the palate) and "AND" (drugs, cocaine, mycosis, syphilis, mucormycosis, tuberculosis, trauma). The PRISMA guide was used to identify the different results of the literature search and article selection process. Case reports and case series were included. RESULTS Five cases of non-syndromic, non-neoplastic palatal perforations were identified. All cases were male with a mean age of 42 years. Two cases were related to cocaine use, 2 cases were caused by mucormycosis, and one case by trauma. As for the systematic literature review, 51 non-neoplastic and non-syndromic cases were collected. The cases showed a male predominance, with a mean age of 41 years. The most frequent etiology was chronic cocaine use followed by mucormycosis. CONCLUSIONS Since cocaine use and type II Diabetes Mellitus, risk factors related to non-syndromic and non-neoplastic palatal perforations, have shown a worldwide increase, the clinician should be alert to make an early diagnosis and initiate appropriate treatment. Key words:Palatal perforation, cocaine-induced, mucormycosis, mycotic infection, drug users.
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Affiliation(s)
| | - Karen Monge
- Dental student, Dental School, University of Sonora, Hermosillo, Sonora, México
| | - Vania Pérez
- Dental student, Dental School, University of Sonora, Hermosillo, Sonora, México
| | | | - Luis-Alberto Gaitán-Cepeda
- Full time Professor of Department of Oral Pathology and Oral Medicine, Graduate and Research Division, Dental School, National Autonomous University of Mexico. Mexico City, Mexico
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Postextraction Mucormycosis in Immunocompromised-Patient Management and Review of Literature. J Oral Maxillofac Surg 2021; 79:1482-1491. [PMID: 33617788 DOI: 10.1016/j.joms.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Mucormycosis is an uncommon aggressive, opportunistic infection that can produce widespread orofacial tissue necrosis. This primarily affects immunocompromised individuals. It is the deadliest and most rapidly progressing type of human-affecting fungal infection. The aim of the study is to investigate the diagnostic criteria and treatment approach in 10 cases of mucormycosis in the author's institute from 2008 to 2019. Moreover, a review of the English literature presents all cases of mucormycosis after tooth extraction. MATERIALS AND METHODS Ten patients at our institute have been treated. They were evaluated and discussed as per their diagnostic criteria, surgical treatment, and mortality rates. RESULTS All 10 immunocompromised patients had a primary hematologic malignancy. The criteria for a positive diagnosis were clinical symptoms and a biopsy for microbiological culture and histologic analysis. Each patient was subjected to vigorous surgical resection and underwent antifungal treatment. Seven patients died because of their main disease. Owing to the unregulated spread of mucormycosis, 2 patients died. Four cases were diagnosed after maxillary tooth extraction. CONCLUSIONS The most important factor for patient survival tends to be the management of the underlying disease with early detection and active surgical and antifungal action. Four of 10 cases diagnosed with mucormycosis appeared after tooth extraction, a relatively high number compared with the literature. Therefore, it is the dental profession's obligation to be familiar with the possibility of the potentially severe and possibly fatal complication.
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Panneerselvam K, Kumar MS, Karthikeyan, Mohan AM. Recurrent mucormycosis - Better understanding of treatment and management. J Family Med Prim Care 2020; 9:6279-6281. [PMID: 33681078 PMCID: PMC7928079 DOI: 10.4103/jfmpc.jfmpc_1220_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/08/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Mucormycosis is a rare opportunistic, aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. It is spread on inhalation, inoculation and wound contamination and is more common in diabetic and other immunocompromised individuals in a population. The clinical and radiological features of Mucormycosis can overlap with other conditions for which a thorough diagnosis should be made. The rate of recurrence in Mucormycosis cases is high. This article reports one such case in which recurrence occurred twice and was controlled only with resection. The main aim of this article is to emphasize the importance of practicing aggressive resection and also on regular follow up of the patient after surgical management. Knowledge on different diagnostic and treatment methods, availability of newer drugs and regular follow up can greatly help in the management and recurrence of Mucormycosis even in immunocompromised patients in a population where diabetes is more common and mortality of rhino cerebral form is high.
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Affiliation(s)
- Karthika Panneerselvam
- Department of Oral Pathology and Microbiology, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
| | - M Sathish Kumar
- Department of Oral Pathology and Microbiology, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
| | - Karthikeyan
- Department of Oral and Maxillofacial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
| | - A Mathan Mohan
- Department of Oral and Maxillofacial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Chinna Kolambakkam, Kanchipuram Dist., Madurantagam, Tamil Nadu, India
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Bhattarai D, Modak A, Suri D. Candidal perforation of the hard palate in an HIV-infected child. BMJ Case Rep 2019; 12:12/12/e233034. [PMID: 31801785 DOI: 10.1136/bcr-2019-233034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dharmagat Bhattarai
- Paediatric Allergy Immunology Unit, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhijit Modak
- Paediatric Allergy Immunology Unit, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Paediatric Allergy Immunology Unit, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rai S, Misra D, Misra A, Jain A, Jain P, Dhawan A. Palatal Mucormycosis Masquerading as Bacterial and Fungal Osteomyelitis: A Rare Case Report. Contemp Clin Dent 2018; 9:309-313. [PMID: 29875579 PMCID: PMC5968701 DOI: 10.4103/ccd.ccd_743_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mucormycosis is an acute, fulminating, fungal disease that frequently involves oral, cranial, and facial structures. It is an opportunistic fatal infection which occurs in debilitating and immunosuppressive states. This report documents a rare case of localized maxillary mucormycosis in a patient with uncontrolled diabetes, with emphasis on early and prompt diagnosis of the same.
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Affiliation(s)
- Shalu Rai
- Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Deepankar Misra
- Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Akansha Misra
- Department of Oral Pathology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Ankit Jain
- Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Prerna Jain
- Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Ayush Dhawan
- Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
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Gargi V, Mohan RPS, Kamarthi N, Gupta S. Palatal Perforation: A Rare Complication of Postanesthetic Necrosis. Contemp Clin Dent 2017; 8:501-505. [PMID: 29042744 PMCID: PMC5644016 DOI: 10.4103/ccd.ccd_123_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The everyday practice of dentistry relies heavily on achieving adequate local anesthesia. Even though the safety record of local anesthetic agents is high, complications do occur. Palate is a favorable site for soft-tissue lesions. Various factors such as direct effects of the drug, blanching of the tissues during injection, relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate. Among various complications, anesthetic necrotic ulcer is a rare and uncommon condition occurring mostly in the hard palate possibly after a local anesthetic infiltration. The ulceration is often deep and shows spontaneous but delayed healing. If proper treatment is not instituted on time, the necrosis can reach deep into the bone causing sequestrum formation and ultimately leading to palatal perforation. Here, we report a case of palatal perforation in a male patient followed by surgical interventions and follow-up.
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Affiliation(s)
- Vidisha Gargi
- Department of Oral Medicine and Radiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | | | - Nagaraju Kamarthi
- Department of Oral Medicine and Radiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Swati Gupta
- Department of Oral Medicine and Radiology, Subharti Dental College, Meerut, Uttar Pradesh, India
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Mengji AK, Yaga US, Gollamudi N, Prakash B, Rajashekar E. Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature. Pan Afr Med J 2016; 23:16. [PMID: 27200123 PMCID: PMC4856500 DOI: 10.11604/pamj.2016.23.16.8394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/01/2015] [Indexed: 12/28/2022] Open
Abstract
Mucormycosis is a rare, highly lethal opportunistic fungal disease affecting immune compromised and diabetic patients. Mucormycosis is considered as the 3rd most common invasive mycosis after candidiasis and aspergillosis in debilitating patients. It is caused by the filamentous fungi of the class zygomycetes. The infection usually begins in the nose due to inhalation of fungal spores. This fatal fungal disease needs a prompt and early definitive diagnosis, aggressive surgical therapy and high dose anti-fungal therapy. Here, we present a case report of Mucormycosis in a 64 year elderly diabetic male patient who was previously operated for myiasis and also the extensive review of the literature of the mucormycosis.
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Affiliation(s)
- Ashwini Kumar Mengji
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Uday Shankar Yaga
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Nishanth Gollamudi
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Bhanu Prakash
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Edunuri Rajashekar
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
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Rhino-orbital mucormycosis with palatal involvement in a child with type 1 diabetes mellitus. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Grant P, Skilbeck CJ. Rhinocerebral mucormycosis: a devastating rhinological condition. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vijayabala GS, Annigeri RG, Sudarshan R. Mucormycosis in a diabetic ketoacidosis patient. Asian Pac J Trop Biomed 2013; 3:830-3. [PMID: 24075351 DOI: 10.1016/s2221-1691(13)60164-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/05/2013] [Accepted: 09/10/2013] [Indexed: 01/02/2023] Open
Abstract
Oral cavity is considered to be a kaleidoscope for body's general health. Many systemic conditions do present with diverse oral manifestations. Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients. Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus. Hereby, we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis.
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Affiliation(s)
- G Sree Vijayabala
- Department of Dentistry, ESIC Medical, College and PGIMSR, K.K. Nagar, Chennai, India.
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Aras MH, Kara MI, Erkiliç S, Ay S. Mandibular Mucormycosis in Immunocompromised Patients: Report of 2 Cases and Review of the Literature. J Oral Maxillofac Surg 2012; 70:1362-8. [DOI: 10.1016/j.joms.2011.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/10/2011] [Accepted: 05/11/2011] [Indexed: 12/11/2022]
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16
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Manjunatha BS, Das N, Sutariya RV, Ahmed T. Mucormycosis of the hard palate masquerading as carcinoma. Clin Pract 2012; 2:e28. [PMID: 24765427 PMCID: PMC3981330 DOI: 10.4081/cp.2012.e28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 12/21/2022] Open
Abstract
A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.
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Affiliation(s)
| | - Nagarajappa Das
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
| | - Rakesh V Sutariya
- Department of Oral Pathology and Microbiology, K.M. Shah Dental College & Hospital
| | - Tanveer Ahmed
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
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Abstract
ABSTRACT
Mucormycosis refers to a severe infection with fungi of order Mucorales, seen in diabetic and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is known to exist in two forms, the well-known acute form and the less well-recognized chronic form. The most common presenting features of the chronic form are ophthalmologic, including ptosis, proptosis, visual loss and ophthalmoplegia. Here, we report a case of chronic rhinocerebral mucormycosis (RCM) presented with nonhealing oroantral fistula in a diabetic patient without any orbital symptoms. We are reporting this case for its unusual presentation.
How to cite this article
Mane RS, Patil BC, Mohite AA. Rhinocerebral Mucormycosis Presenting as Oroantral Fistula. Clin Rhinol An Int J 2012;5(3):135-137.
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Manjunatha BS, Das N, Sutariya RV, Ahmed T. Mucormycosis of the hard palate masquerading as carcinoma. Clin Pract 2012. [PMID: 24765427 DOI: 10.4081/cp.2012.e28.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott's silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.
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Affiliation(s)
| | - Nagarajappa Das
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
| | - Rakesh V Sutariya
- Department of Oral Pathology and Microbiology, K.M. Shah Dental College & Hospital
| | - Tanveer Ahmed
- Department of Oral and Maxillofacial Surgery, SJM Dental College and Hospital, India
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Pak J, Tucci VT, Vincent AL, Sandin RL, Greene JN. Mucormycosis in immunochallenged patients. J Emerg Trauma Shock 2011; 1:106-13. [PMID: 19561989 PMCID: PMC2700608 DOI: 10.4103/0974-2700.42203] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 07/20/2008] [Indexed: 11/17/2022] Open
Abstract
Mucorales species are deadly opportunistic fungi with a rapidly invasive nature. A rare disease, mucormycosis is most commonly reported in patients with diabetes mellitus, because the favorable carbohydrate-rich environment allows the Mucorales fungi to flourish, especially in the setting of ketoacidosis. However, case reports over the past 20 years show that a growing number of cases of mucormycosis are occurring during treatment following bone marrow transplants (BMT) and hematological malignancies (HM) such as leukemia and lymphoma. This is due to the prolonged treatment of these patients with steroids and immunosuppressive agents. Liposomal amphotericin B treatment and posaconazole are two pharmacologic agents that seem to be effective against mucormycosis, but the inherently rapid onset and course of the disease, in conjunction with the difficulty in correctly identifying it, hinder prompt institution of appropriate antifungal therapy. This review of the literature discusses the clinical presentation, diagnosis, and treatment of mucormycosis among the BMT and HM populations.
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Affiliation(s)
- Jane Pak
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, Florida 33612-4742, USA
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Rare mycoses of the oral cavity: a literature epidemiologic review. ACTA ACUST UNITED AC 2010; 108:647-55. [PMID: 19836721 DOI: 10.1016/j.tripleo.2009.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 11/22/2022]
Abstract
Stomatologic fungal infections display different etiologies, pathogenesis, and clinical presentations. The incidence of rare mycoses of oral cavity is very low. These infections can involve both immunocompromised and immmunocompetent patients with common predisposing factors, such as diabetes or suffering from diseases causing immune system impairment. Oral mycoses can cause acute, chronic, and mucocutaneous lesions. Candidiasis is the most common mouth mycosis. Although occasionally primary mouth pathogens, Cryptococcus spp. or filamentous fungi (Aspergillus spp. and zygomycetes) can cause oral mycoses, with the oral localization more commonly secondary to a more serious systemic infection. The diagnosis of oral mycoses is based on clinical examination; for yeasts, culture is necessary to identify the etiologic agents; for filamentous fungi, in particular for zygomycetes and dimorphic, a definitive diagnosis can be made by histologic examination and pertinent stains with or without isolation of the fungus from the same site.
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Hard palate perforation in acute lymphoblastic leukemia due to mucormycosis - a case report. Indian J Hematol Blood Transfus 2009; 25:36-9. [PMID: 23100971 DOI: 10.1007/s12288-009-0009-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 02/24/2009] [Indexed: 10/20/2022] Open
Abstract
Palatal perforation can occur due to trauma, infection and malignancy. Mucormycosis is a rare opportunistic fungal infection caused by an organism of class zygomycetes. Rhinocerebral mucormycosis is the most common type of mucormycosis that typically starts in maxillary antrum in immunocompromised patients. Invasion of surrounding structures leads to necrotizing ulcer of the hard palate and ultimately leads to perforation. Here, we report a case of perforation of the hard palate due to mucormycosis in a eight years child having acute lymphoblastic leukemia (ALL), who was on prolonged chemotherapy and corticosteroid therapy. This case is being reported for its rarity. The aim of presenting this case report is to emphasize that the infection due to mucomycosis should be included in the differential diagnosis of hard palate perforation in ALL patients who are immunocompromised.
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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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