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Post-COVID-19 Maxillary Bony Sequestration: A Case Report on Mucormycosis Challenges
Saleh Mohebbi1, Mohammadsadegh Zabihidan2, Ali Omidvari1
1ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital Iran University of Medical Sciences Tehran Iran.
Abstract:
COVID-19-associated mucormycosis (CAM) is a severe opportunistic infection, typically affecting immunocompromised patients. Maxillary bony sequestration as a delayed complication in immunocompetent individuals is rare, highlighting diagnostic and therapeutic challenges. A 31-year-old male with no comorbidities presented in September 2021 with COVID-19 pneumonia (Delta variant), treated with dexamethasone and remdesivir. In October 2021, he developed right maxillary hypoesthesia and cheek swelling. Nasal endoscopy and biopsy confirmed mucormycosis, managed with liposomal amphotericin B and endoscopic debridement. In February 2023, malodor and tooth loosening prompted imaging, revealing maxillary bony sequestration due to fungal-induced vascular thrombosis and necrosis, treated with surgical resection and prosthetic reconstruction. One-month follow-up (March 2023) showed no recurrence or complications, though the short follow-up limits long-term conclusions. This case underscores maxillary bony sequestration as a rare, delayed complication of CAM, even in immunocompetent patients. Persistent symptoms like malodor or tooth mobility warrant imaging and surgical evaluation. Long-term follow-up is crucial to detect and manage such sequelae.

