A Rare Case of Mandibular Mucormycosis in a Post-COVID-19 Patient

Temporomandibular joint ankylosis is caused by trauma, infection, autoimmune, inflammatory joint diseases, and several other minor causes. Mucormycosis causing temporomandibular joint ankylosis has not been reported. We report two cases of temporomandibular joint ankylosis caused by mucormycosis from 2018 to 2022. In both cases, the infection started in the maxilla, then progressed to orbit. After that, involvement of the mastoid process, styloid process, and base of the skull was observed in the first case, while in the second case, there was the involvement of the base of the skull and mandibular ramus. As the temporomandibular joint (TMJ) components are contiguous to the base of the skull, it got affected causing temporomandibular joint ankylosis. Mucormycosis was diagnosed by KOH mount. The smear examination showed aseptate hyphae at 90 0 . Histopathology examination further confirmed mucormycosis. Glycemic control was done by infusing Insulin (both Lantus and regular). The case was managed with aggressive debridement and interpositional arthroplasty with a buccal fat pad. Liposomal amphotericin infusion was also started pre-operatively and continued in the post-operative phase. After 4 years of follow-up, the patient is well and had adequate mouth opening.Mucormycosis infection affecting the TMJ has been reported in the literature. However, this is the first report of a mucormycosis infection resulting in TMJ ankylosis in the literature. The infection should be aggressively managed. Reversals of an immunocompromised state, aggressive surgical management, and antifungal medication are the key factors for the success of the deadly fungal infection.

Section: Discussionmentioning

confidence: 99%

Rhino-Orbital Cerebral Mucormycosis Causing Temporomandibular Joint Ankylosis: A Case Series of Two Patients

Mokhtar¹,

Fatima²,

Akbar³

et al. 2023

“…Mucormycosis is not an unfamiliar condition in India; the incidence rate before 2019 was almost 70 times higher than that in developed countries [ 5 ]. A 10-times surge has been seen globally in fungal infections with the emergence of the COVID-19 pandemic, and rhinocerebral and pulmonary mucormycosis has been the most common variant [ 6 , 7 , 8 ]. Corticosteroids, i.e., dexamethasone and methylprednisolone, are routinely prescribed for COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Analyzing the success rate of resection over curettage, initially, the second resection of the involved area was planned; however, intraoperatively, after the removal of necrotic medullary bone, bleeding was noted from cortical plates, and hence the plan was changed to the preservation of bone as it was not clinically involved. Haidry et al [ 8 ] have successfully managed a case of MOM, which had developed after COVID-19 infection, in a 59-year-old man by open surgical debridement. Similarly, Cohen et al [ 13 ] have managed three cases, and Ambereen et al [ 14 ] have managed one case of mandibular mucormycosis by debridement and curettage of the area.…”

Section: Discussionmentioning

confidence: 99%

Mandibular Mucormycosis: A Report of Four Cases and a Discussion on Their Management

Mokhtar¹,

Haidry²,

Karishma³

et al. 2022

Self Cite

Mucormycosis of the mandible (MOM) is a rare fungal infection, and only 23 cases had been reported during the last 50 years worldwide, from seven different countries. Most of the cases were reported in India (n=8, 34%), followed by the United States (n=5, 22%). It is usually associated with an immunocompromised state and generally occurs after tooth extraction. Radiographically, it presents with the characteristic sign of osteomyelitis. Most of the previous case reports/series on MOM described successful outcomes with the resection of the involved segment. However, our experience in managing these cases was quite different and it was observed that resection is seldom required. It was seen that MOM rarely causes cortical perforation. One of the probable reasons is the thicker cortical bone and well-confined boundary of the mandible. Another reason could be the fulminating nature of the disease that leads it to rapidly spread in less resistant medullary bone before perforating cortical bone. During surgery, a clear line was seen separating necrotic medullary bone from healthy cortical bone. The thicker cortical bone of the mandible was found to be resistant to fungal invasion; however, the medullary bone was rapidly invaded. Therefore, the healthy cortical bone could be saved. The preservation of the cortical parts thus helps in maintaining the continuity of the bone. Surgical curettage of necrotic medullary bone is usually the optimal method to manage MOM affecting the mandibular body or ramus region.

“…As we set foot in the 21st century, mankind is being endangered by multiple ailments which have forced humanity to put the world on hiatus. Apart from COVID-19, one such threat that rose is mucormycosis, an angioinvasive infection acquired by a saprophytic fungus that has proved to be ubiquitous [ 1 - 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…As of May to July 2021 India has confirmed more than 47,000 new cases of mucormycosis compared with the rest of the nations [ 5 ]. The sudden surge of the disease is due to the increasing prevalence of comorbid people, iron overload, and overdosage with injudicious use of corticosteroids among COVID-19 patients [ 1 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Knowledge Regarding Mucormycosis and Its Management Among a Cohort of Dental Undergraduates in India: A Cross-Sectional Survey

et al. 2023

Introduction: Mucormycosis is an angioinvasive fungal infection associated with a high mortality rate in both low- and middle-income countries. A dentist plays a crucial role and first line in the diagnosis and treatment of mucormycosis since the majority of the site of infection is the rhino cerebral or rhino maxillary area. The present study was designed to ascertain knowledge about mucormycosis and its management among a sample of dental undergraduates in India. Materials and methods: A self-administered questionnaire covering demographic details, knowledge relating to underlying disease and risk factors (10 items), clinical features and diagnosis (8 items), and management of mucormycosis (six items) was employed. Responses were recorded on a dichotomous scale. Data analysis was done using SPSS 20 (SPSS Inc., Chicago, IL, USA). The mean and standard deviation for correct answers and knowledge levels were determined. Results: A total of 437 respondents were included. Classification of participants based on the level of correct knowledge demonstrated that the majority of students had good knowledge (232, 53.1%). Comparison of the same based on the college type showed significant differences for only clinical features, diagnosis (p=0.002), and management (p=0.035) whereas no significance was seen for gender. Correlation by Karl’s Pearson correlation coefficient revealed a significant positive correlation between the entire knowledge scores. Conclusion: The study portrays adequate knowledge among dental interns that can be used to modify preventive care measures to lessen the public health emergency. Stakeholders can take the necessary action to spread knowledge about mucormycosis through training workshops and continuing dental education programs to combat the health crisis.