Maxillary osteomyelitis by mucormycosis: report of four cases

Abstract

Mucormycosis is a fungal infection commonly affecting structures in the head and neck, such as the air sinuses, orbits, and the brain. Common predisposing factors include diabetes mellitus and immunosuppression. We describe our clinical experience with four cases of mucormycosis of the maxillary antrum associated with uncontrolled diabetes mellitus managed at our centre. Early diagnosis and prompt treatment can significantly reduce the mortality and morbidity of this lethal fungal infection.

Fulminant Mucormycosis Involving Paranasal Sinuses: A Rare Case Report

“…Such patients have decreased granulocyte phagocytic ability with altered polymorphonuclear leukocyte response [7]. In diabetic patients Rhizopus arrhizus produce the enzyme ketoreductase, which allows them to utilize the patient's ketone bodies [8]. The increased risk of mucormycosis in patients with ketoacidosis may also be due to the release of iron bound to proteins [4].…”

“…Advancing infection usually spreads from the ethmoid sinus to the orbit, resulting in loss of extraocular muscle function and proptosis with marked chemosis and can quickly result in cavernous sinus thrombosis, carotid artery, or jugular vein thrombosis (Lemierre syndrome) and death [9, 10]. A clinical suspicion of mucormycosis requires confirmation by radiological examination, preferably a CT scan of the maxilla and orbit, showing membrane or periosteal thickening and bony disruption [8]. Imaging findings may be nonspecific and include unilateral or bilateral pan sinus inflammatory changes such as polypoid mucosal thickening.…”

Mucormycosis of the head and neck: Report of five cases with different presentations

“…This black eschar, in the palatal or intranasal region, is highly suggestive of mucormycosis, but it is not always present, being seen in between 14.8% (Mohindra et al, 2007) and 40% of patients (Munir and Jones, 2007), which similar to our series where it was present in two patients. Mucormycosis has been reported as a complication of different pathologies, such as after dental extraction (Pandey et al, 2011;Kim et al, 2001), chronic sinusitis of dental origin (De Biscop et al, 1991), acute leukaemia in a patient with a haematological malignancy (McDermott et al, 2010) or a complication of long-term immunosuppression in transplant recipients (Uçkay et al, 2007) whose incidence has been reported about 0.4e1.6% (Ramos et al, 2009) Prompt diagnosis is very important, allowing earlier control of the infection and improving patient survival (Spellberg et al, 2009). Computed tomography (CT) is considered to be the initial imaging method of choice for the detection of mucormycosis, however in the early stages of the disease findings may be non-specific (Dhiwakar et al, 2003;Scheckenbach et al, 2010) and even invasive mucormycosis may be present with a normal sinus CT.…”

Infantile maxillary sinus osteomyelitis mimicking orbital cellulitis

“…There is also predisposition of diabetics to develop maxillary osteomyelitis. [17] In another review of osteomyelitis of the jaw in West African population, Khullar et al . [18] found only six cases of osteomyelitis of maxilla out of the total 60 cases of osteomyelitis involving both jaw bones (maxilla and mandible).…”