Home Print this page Email this page
Users Online: 4554
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 184-186

Prosthetic rehabilitation of a patient with facial mucormycosis


Department of Prosthodontics, Vasantdada Patil Dental College, Sangli, Maharashtra, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Digvijay Sanjay Deshpande
Department of Prosthodontics, Vasantdada Patil Dental College, Sangli - 416 416, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.138603

Rights and Permissions
  Abstract 

Facial mucormycosis is a known complication in patients with immunological or metabolic compromise. Mainstay of treatment includes reversal of the compromised state, systemic antifungals and repeated radical debridements. The resultant deformity following debridement causes gross morbidity and psycho-social embarrassment. Surgical reconstruction is difficult on account of co-morbid diseases. Nonsurgical prosthetic rehabilitation gives fairly accurate correction in these patients. We report a case of a 62-year-old male diabetic with facial mucormycosis where debridement resulted in a gross morbid defect. However, effective rehabilitation was achieved using extraoral prosthesis.

Keywords: Acrylic resins, extra oral defect, fungal infection, prosthetic rehabilitation


How to cite this article:
Deshpande DS, Limaye MB, Ramesh S, Mishra K. Prosthetic rehabilitation of a patient with facial mucormycosis. Int J Health Allied Sci 2014;3:184-6

How to cite this URL:
Deshpande DS, Limaye MB, Ramesh S, Mishra K. Prosthetic rehabilitation of a patient with facial mucormycosis. Int J Health Allied Sci [serial online] 2014 [cited 2024 Mar 28];3:184-6. Available from: https://www.ijhas.in/text.asp?2014/3/3/184/138603


  Introduction Top


Mucormycosis is a fungal infection commonly reported in immunocompromised patients such as poorly controlled diabetes mellitus, blood dyscrasias, malnutrition, neutropenia, iron overload, organ transplant, and immunosuppressive therapy. [1] Unless contained, this disease can be fatal. With the invention of modern chemotherapy, mortality of this disease is greatly reduced. The degree of morbidity in the patients who have survived depends upon how quickly the disease is diagnosed and treated. [2] The disease has potential to advance throughout the entire midfacial region, maxilla, orbital contents and then to the cranium. It is significant, however, that the patients who have survived the disease suffered either orbital destruction or maxillary destruction, but not both. [3] Residual defects include decreased vision, oroantral fistula, oronasal communication and a prominent facial defect. [3] This report presents a case of prosthetic rehabilitation of extensive extra oral defect due to mucormycosis of cheek, using acrylic resin material.


  Case report Top


A 62-year-old male was referred to Department of Prosthodontics, following maxillectomy. Patient was a known diabetic since the last 20 years taking insulin for control of diabetes mellitus. Following an episode of diabetic ketoacidosis, he developed rapidly spreading naso-orbital mycosis and gangrene necessitating emergency maxillectomy on the right side of the face.

There was residual slough present in the wound, which was then debrided under systemic antifungal cover (intravenous fluconazole 6 mg/kg once daily for 2 weeks).

After complete healing of wounds, patient was considered for maxillofacial prosthesis [Figure 1]. There was a prominent defect involving lateral wall of nose, maxilla, and nasal septum.
Figure 1: Extraoral view

Click here to view


For the fabrication of the prosthesis, extraoral moulage impression was made with irreversible hydrocolloid (Imprint, DPI, India) [Figure 2]. Impression was immediately debrided and cast was poured in dental stone [Figure 3]. Wax pattern of the missing part of the face was fabricated on the working cast and a hole was provided in the pattern simulating right nasal aperture [Figure 4].
Figure 2: Moulage impression

Click here to view
Figure 3: Working cast

Click here to view
Figure 4: Wax pattern

Click here to view


The wax pattern was then invested in dental flask using dental plaster. Dewaxing was done [Figure 5] and the flask was then packed with clear poly methyl methacrylate denture base resin (Dpi India). Heat polymerization was performed according to manufacturer's instruction.
Figure 5: Plaster mould

Click here to view


After retrieval of the prosthesis from the flask, the tissue surface polishing was performed. Polished tissue surface would not allow deposition of any debris at the site. Extrinsic acrylic colors were used for color matching with the skin.

An innovative technique was used for retention of the prosthesis. Prosthesis was placed in the defect and patient was asked to wear spectacles. Later, the prosthesis was connected to the spectacles with help of self-cure acrylic resin, near the bridge of the nose. Small amount of acrylic resin was then applied encircling the part of spectacle near nasal bridge, and then it was painted with black color to match with frame of the specs [Figure 6]. The rigid fixation was achieved between spectacles and the prosthesis [Figure 7]. The prosthesis maintained its position even after bending forward and performing vigorous facial muscle movement.
Figure 6: Extraoral prosthesis

Click here to view
Figure 7: Posttreatment view

Click here to view


After 2 months, follow-up was done. Patient was happy with the prosthesis. Then, he was advised to visit the department every month for follow-up.


  Discussion Top


Sino-nasal mycosis is a rapidly progressive invasive fungal infection in patients with immunological or metabolic compromised conditions. [1] Though survival in a given case has improved dramatically, number of deaths is increasing along with the rise in incidence of immunodeficiency and opportunistic infections, especially when recognition and treatment have been delayed. [4] Such infections are uncommon in routine practice of a plastic surgeon. [5] When one is confronted with such a case, awareness will help initiate immediate action. [6] Necrotizing fasciitis of the face has to be considered in differential diagnosis. [7] A team approach involving the ophthalmologist, oto-rhino-laryngologist, clinical microbiologist and plastic surgeon is needed to help patient survive the disease with good result. [8],[9],[10] Necrotizing and progressive nature of infection along with propensity of infecting agent to invade arterioles causing an ischemic environment necessitates multiple debridements. [11]

Our patient was a middle aged diabetic who developed invasive disease during an episode of ketoacidosis. Repeated imaging and surgical debridement helped to achieve control of disease at the cost of a massive midface defect. Enormity of composite defect and co-morbid conditions posed a significant risk for major surgical reconstruction and anesthesia. A single piece extraoral prosthesis provided quick and inexpensive rehabilitation with minimum risk. The maxillo-facial prosthesis met the patients functional and aesthetic needs adequately. Attaching the prosthesis to the spectacles provided better retention and comfort to the patient.


  Conclusion Top


This clinical report describes prosthetic rehabilitation of a patient having sino-nasal mucormycosis and midfacial defect. The patient was diabetic and the rehabilitation was achieved with the prosthesis fabricated in heat cure acrylic resin. Acceptable color matching was achieved with acrylic colors and retention by attaching it to the spectacles.

 
  References Top

1.Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;33:349-65.  Back to cited text no. 1
[PUBMED]    
2.Cagatay AA, Oncü SS, Calangu SS, Yildirmak TT, Ozsüt HH, Eraksoy HH. Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin B and incomplete surgery: A case report. BMC Infect Dis 2001;1:22.  Back to cited text no. 2
    
3.Koçak R, Tetiker T, Koçak M, Baºlamiºli F, Zorludemir S, Gönlüºen G. Fluconazole in the treatment of three cases of mucormycosis. Eur J Clin Microbiol Infect Dis 1995;14:559-61.  Back to cited text no. 3
    
4.Bhattacharyya AK, Deshpande AR, Nayak SR, Kirtane MV, Ingle MV, Vora IM. Rhinocerebral mucormycosis: An unusual case presentation. J Laryngol Otol 1992;106:48-9.  Back to cited text no. 4
    
5.Aköz T, Civelek B, Akan M. Rhinocerebral mucormycosis: Report of two cases. Ann Plast Surg 1999;43:309-12.  Back to cited text no. 5
    
6.Lari AR, Kanjoor JR, Vulvoda M, Katchy KC, Khan ZU. Orbital reconstruction following sino-nasal mucormycosis. Br J Plast Surg 2002;55:72-5.  Back to cited text no. 6
    
7.Peterson KL, Wang M, Canalis RF, Abemayor E. Rhinocerebral mucormycosis: Evolution of the disease and treatment options. Laryngoscope 1997;107:855-62.  Back to cited text no. 7
    
8.Djokic M, Bojic I, Mikic D, Ivanovic A, Drincic R, Markovic Lj, et al. Rhino-orbital zygomycosis. Vojnosanit Pregl 2001;58:551-6.  Back to cited text no. 8
[PUBMED]    
9.Esakowitz L, Cook SD, Adams J, Doyle D, Grossart KW, Macpherson P, et al. Rhino-orbital-cerebral mucormycosis: A clinico-pathological report of two cases. Scott Med J 1987;32:180-2.  Back to cited text no. 9
    
10.Dökmetaº HS, Canbay E, Yilmaz S, Elaldi N, Topalkara A, Oztoprak I, et al . Diabetic ketoacidosis and rhino-orbital mucormycosis. Diabetes Res Clin Pract 2002;57:139-42.  Back to cited text no. 10
    
11.Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D′Souza O. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol 2003;51:231-6.  Back to cited text no. 11
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


This article has been cited by
1 The rising challenge of mucormycosis for maxillofacial prosthodontists in the Covid-19 pandemic: A literature review
Islam E. Ali, Anshul Chugh, Towithelertkul Cheewin, Mariko Hattori, Yuka I. Sumita
Journal of Prosthodontic Research. 2022;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed3680    
    Printed168    
    Emailed0    
    PDF Downloaded327    
    Comments [Add]    
    Cited by others 1    

Recommend this journal