Prosthetic Rehabilitation of Rhino Orbital Mucormycosis Associated with COVID-19: A Case Series
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Published on: October 13, 2017
M B Ravi1, Sowmya Srinivas1, Ekaterina Silina2
1Department of Prosthodontics, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India.
Abstract:
Mucormycosis, a rare fungal infection seen in diabetes, is now very frequent owing to the deadly triad of COVID-19 infection, diabetes, and rampant use of corticosteroids. Immediate management revolves around therapeutic drugs like antifungals, antibiotics, and aggressive surgical debridement. The cases described in the article explain prosthetic rehabilitation of maxillectomy defects. The findings focus on prosthetic rehabilitation of patients with acquired maxillectomy defects after mucormycotic necrosis post-COVID-19 infection and the techniques to overcome the complications like lack of supporting tissues and post-surgical microstomia. The maxillectomies were performed on patients who suffered a superinfection of mucormycosis after COVID-19 contraction and uncontrolled blood sugar levels. Case 1 elaborates a technique to overcome the complications like lack of supporting structures and microstomia by fabrication of sectional and hollow obturator prostheses using sectional impression technique and lost salt technique. Case 2 explains the management of an extensive defect with a mobile soft tissue flap and lone standing tooth by using a functional impression technique to gain retention and support from the remaining soft and hard tissues. Both the techniques overcome the clinical complications and give predictable outcomes. Prosthetic rehabilitation of such challenging cases needs modifications depending upon the clinical challenges encountered.
Insights
Mucormycosis, a fungal infection exacerbated by COVID-19, diabetes, and steroids, requires surgical intervention. This study details prosthetic rehabilitation techniques for maxillectomy defects, addressing complications like tissue loss and microstomia.
Area of Science:
- Oral and Maxillofacial Surgery
- Prosthodontics
- Infectious Diseases
Background:
- Mucormycosis, a severe fungal infection, has surged due to the COVID-19 pandemic, uncontrolled diabetes, and corticosteroid use.
- Surgical debridement is critical for managing mucormycosis, often resulting in significant maxillectomy defects.
- Rehabilitating these defects presents challenges, including lack of supporting tissues and post-surgical microstomia.
Observation:
- This study presents two cases of prosthetic rehabilitation for maxillectomy defects in patients with a history of mucormycosis post-COVID-19.
- Case 1 involved fabricating sectional and hollow obturator prostheses using sectional impression and lost salt techniques.
- Case 2 utilized a functional impression technique for an extensive defect with a mobile soft tissue flap and a single tooth.
Findings:
- Both prosthetic techniques successfully addressed complications such as limited supporting structures and microstomia.
- The sectional/hollow obturator and functional impression techniques provided predictable outcomes for complex maxillectomy defects.
- Customized prosthetic solutions are essential for managing diverse clinical challenges in post-mucormycosis maxillectomy patients.
Implications:
- Effective prosthetic rehabilitation can significantly improve the quality of life for patients with post-mucormycosis maxillectomy defects.
- The described techniques offer viable solutions for restoring function and aesthetics in challenging surgical defects.
- Further research into modified prosthetic designs may enhance outcomes for this vulnerable patient population.
