Post-COVID-19 Maxillary Bony Sequestration: A Case Report on Mucormycosis Challenges

Area of Science:

• Infectious Diseases
• Otolaryngology
• Oral and Maxillofacial Surgery

Background:

• COVID-19-associated mucormycosis (CAM) is a severe opportunistic infection, predominantly affecting immunocompromised individuals.
• Maxillary bony sequestration presents a rare and delayed complication of CAM, posing diagnostic and therapeutic challenges, particularly in immunocompetent patients.

Purpose of the Study:

• To report a case of maxillary bony sequestration as a delayed complication of CAM in an immunocompetent patient.
• To highlight the diagnostic and therapeutic considerations for this rare sequela of mucormycosis.

Main Methods:

• A case study of a 31-year-old immunocompetent male with COVID-19 pneumonia (Delta variant) who developed maxillary hypoesthesia and cheek swelling.
• Diagnosis of mucormycosis was confirmed via nasal endoscopy and biopsy, treated with liposomal amphotericin B and endoscopic debridement.
• Delayed maxillary bony sequestration was identified through imaging, managed with surgical resection and prosthetic reconstruction.

Main Results:

• The patient presented with delayed maxillary bony sequestration, attributed to fungal-induced vascular thrombosis and necrosis, despite initial treatment for mucormycosis.
• Surgical intervention including resection and prosthetic reconstruction successfully managed the bony sequestration.
• A one-month follow-up showed no recurrence, though longer observation is needed.

Conclusions:

• Maxillary bony sequestration can occur as a rare, delayed complication of CAM, even in immunocompetent individuals.
• Persistent symptoms such as malodor or tooth mobility warrant thorough investigation, including imaging and surgical assessment.
• Long-term follow-up is essential for managing potential sequelae of CAM.