Incidence and Treatment Protocol for Maxillofacial Fungal Osteomyelitis: A 12-Year Study

The aim was to retrospectively determine the incidence of fungal osteomyelitis and outcome of the surgical protocol and complications.

Data were recorded from the medical records of patients treated from 2006 to 2018. Predictor variables were drawn from demographic characteristics (age and gender), etiology, most common site, associated comorbidities involved, and treatment protocol followed. The outcome variables were the success rate and associated complications.

We identified 50 patients with fungal osteomyelitis out of 153 who were treated for various types of osteomyelitis for 12 years. The incidence was 32.6%; men were affected more than women, at a ratio of 2.5:1; and most common site was the maxilla (56%), followed by the mandible (32%) and other sites (12%). Treatment protocols were dependent on the nature of the lesion, site, and optimization of underlying comorbid conditions. The outcome of our protocol showed that 28 patients (56%) healed well. Patients with complications such as palatal fistula (13 [26%]) underwent revision surgery using a local advancement flap and the buccal fat pad. During the immediate postoperative period, 2 patients (4%) had wound dehiscence; 2 patients (4%) had nasal regurgitation; and 1 patient (2%) had a reduced mouth opening that was managed with a mouth-opening exercise regimen. In 1 patient (2%) with recurrence, secondary correction was performed after 6 months and postoperative antifungal therapy was administered for 3 months.

The incidence of fungal osteomyelitis was high owing to associated comorbidities. The surgical outcome was markedly influenced by a prompt diagnosis based on the clinical presentation and histopathology, identification and optimization of comorbidities, correction of electrolyte imbalances, 2 doses of amphotericin B preoperatively under an intensive care unit setup, intraoperative collection of specimens for fungal culture by a microbiologist, curettage and debridement of the soft tissue and bone, closure of the defect with either a local or regional flap, and postoperative antifungal therapy.