Mucormycosis in head and neck area - the emerging health problem in COVID-19 pandemic. The perspective of a dental practitioner.

Mucormycosis is an invasive fungal disease caused by saprophytic molds and is characterized by a fulminant course and high mortality. Reported increase of disease cases and more frequent mucormycosis superinfections in COVID-19 patients are of a serious concern. Head and neck area is the most typical location of mucormycosis and often the first symptoms are eminent in oral cavity, therefore a dentist may be the first healthcare practitioner to recognize signs of this dangerous and potentially fatal disease. Urgent diagnosis and implementation of appropriate treatment are essential for the patient's survival. The dentist's participation in postoperative care is necessary and due to the destructive nature of radical surgical treatment, prosthetic rehabilitation is required to improve the patient's function and quality of life. Furthermore the vigilance of dentists will also allow early recognition of frequent recurrences of this insidious infection.

Prosthetic rehabilitation of a maxillary defect with a bone anchored prosthesis: A clinical report.

Mucormycosis is an opportunistic fungal infection that frequently infects sinuses, brain, or lungs and arises mostly in immunocompromised patients. Although its occurrence in the maxilla is rare, debridement and resection of the infected and necrotic area is often the best treatment but usually results in an extensive maxillary defect. Protocols for prosthetic obturation versus microvascular reconstruction have been established and used effectively in tertiary institutions for patients with such large defects. Aramany Class VI defects involving more than half of the palatal surface can be managed effectively by surgical reconstruction using microvascular free flaps as a platform for supporting bone-anchored prostheses. Providing fixed prostheses may offer advantages over a conventional obturator prosthesis in terms of hygiene, function, and esthetics. Nonetheless, fixed prostheses retained by endosseous implants in patients with reconstructive osteomyocutaneous flaps often require a sequential team approach by the surgeon and prosthodontist. This clinical report describes the reconstruction of a maxilla by using a scapular free flap with subsequent prosthetic rehabilitation in a patient with maxillary sinus infection secondary to mucormycosis.

Prosthetic rehabilitation of acquired maxillary defects secondary to mucormycosis: clinical cases.

Maxillary necrosis can occur due to bacterial infections such as osteomyelitis, viral infections, such as herpes zoster or fungal infections, such as mucormycosis, aspergillosis etc. Mucormycosis is an opportunistic fungal infection, which mainly infects immunocompromised patients. Once the maxilla is involved, surgical resection and debridement of the necrosed areas can result in extensive maxillary defects. The clinician is to face many a challenge in order to replace not only the missing teeth, but also the lost soft tissues and bone, including hard palate and alveolar ridges. The prosthesis (Obturator) lacks a bony base and the lost structures of the posterior palatal seal area compromise retention of the prosthesis. Furthermore, the post surgical soft tissues are scarred and tense, which exert strong dislodging forces. The present article describes the prosthetic rehabilitation of maxillary necrosis secondary to mucormycosis in two cases, one completely edentulous and the other partially edentulous.

The rising challenge of mucormycosis for maxillofacial prosthodontists in the Covid-19 pandemic: A literature review.

PURPOSE: This review examines the importance of prosthetic rehabilitation after surgical treatment of mucormycosis in the context of expected increases in cases during the current COVID-19 pandemic. STUDY SELECTION: Google Scholar, Web of Science, Scopus, and PubMed databases were searched for relevant articles published between 2010 and 2021. Articles that provided a full description of prosthetic treatment after surgical treatment of mucormycosis were included in the review. RESULTS: Out of 30 articles describing orofacial prosthetic rehabilitation after surgical treatment of mucormycosis published during the 12-year target period, 19 reported patients with diabetes, two described mucormycosis as a post-COVID-19 complication, and 25 were reports from India. Most of the prosthetic treatments used a definitive obturator (63.3%) either alone or in combination with other forms of prosthetic rehabilitation. Other prosthetic strategies included an orbital prosthesis (26.6%), a facial prosthesis with or without a nasal replacement (16.6%), a surgical or interim obturator, a conventional complete denture, and a cast partial denture. Six articles (20%) mentioned the use of combined prosthetic rehabilitation involving multiple regions of the face and oral cavity. CONCLUSION: Prosthetic rehabilitation after surgical treatment of mucormycosis is essential for the early restoration of oral function and facial esthetics. Given the aggressive nature of mucormycosis and the increasing number of cases reported during the COVID-19 pandemic, prosthodontists need to share their experiences with prosthetic rehabilitation of the defects that result from this disease to improve patients' quality of life.

Mucormycosis: oral and prosthodontic implications. A report of 14 patients.

This report includes 14 patients with rhinocerebral mucormycosis treated at the UCLA Medical Center since 1970. This disease has an extremely high mortality and morbidity. It is of interest to dentists because of the common presenting symptoms of periorbital cellulitis and sinusitis and the occasional presenting symptoms of dental pain or subperiosteal swelling. It is of further interest because of the intraoral and extraoral midfacial defects that result from disease extension and the necessary surgical débridement. The resultant facial and oral defects are far more difficult to restore than similar defects secondary to resection of head and neck neoplasms.

Potential risk of serious oral infections in the diabetic patient: a clinical report.

Diabetes has many manifestations, including increased vulnerability to bacterial and fungal infections, that may be of concern to the dental profession. Oral candidosis and other opportunistic fungal infections may be early, nonspecific signs of uncontrolled diabetes. Rhinocerebral involvement often extends to the paranasal sinuses, pharynx, palate, orbit, and brain, causing severe tissue destruction and necrosis. This clinical report describes a young woman with diabetes who developed mucormycosis of the maxilla. Tissue destruction resulted in loss of the entire premaxilla, the anterior half of the hard palate, and all maxillary teeth except for the right and left second molars. An interim clear acrylic resin prosthesis was fabricated to restore facial contours and speech and to allow mastication. This prosthesis subsequently was duplicated, and teeth were added for improved lip support, esthetics, and mastication.