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CASE REPORT |
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Year : 2014 | Volume
: 3
| Issue : 3 | Page : 184-186 |
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Prosthetic rehabilitation of a patient with facial mucormycosis
Digvijay Sanjay Deshpande, Milind B Limaye, Sachhi Ramesh, Koyena Mishra
Department of Prosthodontics, Vasantdada Patil Dental College, Sangli, Maharashtra, India
Date of Web Publication | 13-Aug-2014 |
Correspondence Address: Digvijay Sanjay Deshpande Department of Prosthodontics, Vasantdada Patil Dental College, Sangli - 416 416, Maharashtra India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2278-344X.138603
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 | | |
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 | | |
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.
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].
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.
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.
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 | | |
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 | | |
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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
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