Mucormycosis of jaws – literature review and current treatment protocols

Abstract

Mucormycosis is a modern-day lifestyle disease that has burst into the health-care scenario. It is an opportunistic fungal infection that proliferates into the immunocompromised host by invasion of the fungus into the paranasal sinuses, thereby invading the palate, maxilla, and orbit. Left untreated it invades the cranial components such as cavernous sinus, skull base, and brain. Mucormycosis invades blood vessels, making these infections highly angioinvasive. We reviewed 45 cases of mucormycois of the head-and-neck region from 2010 to 2020 on the basis of electronic search peer-reviewed journals in Medline (PubMed) database. Presenting symptoms, risk factors, history of extraction, and treatment were tabulated and the data were analyzed. The mean age of patients was 53.8 years. 73.93% of patients had diabetes mellitus, 13.63% of patients had no immunocompromised state, and 8.74% of patients had other medical disorders. About 34.78% of cases had a history of extraction prior to manifestation of symptoms. Mucormycosis remains difficult to treat disease with a high mortality rate. At present, the triad of clinician's awareness, appropriate antifungal therapy, and aggressive surgical intervention represents treatment protocols against the disease.

Oral Manifestations of Mucormycosis: A Systematic Review

“…We used the STROBE guide to conduct a cross-sectional study, which is based on 22 points related to different parts of the articles [16]. The articles were classified according to the points they met to determine study bias: low risk (16)(17)(18)(19)(20)(21)(22), moderate risk (8)(9)(10)(11)(12)(13)(14)(15) and high risk (≤7).…”

“…Usually it can the hematoxylin-eosin stain (H-E) (Figure 2), but if there are fewer samples or tration in the sample is low, calcofluor white is used, which makes it easier to Even so, there are cases where the diagnosis is unclear, and polymerase cha (PCR) is used to detect fungal DNA up to 3 days earlier than histopathologica [3]. Common primary extra-oral signs of infection include headache, sinus pain, congestion, and bloody nasal discharge [9]. Other signs can also appear, such as fever, facial pain and swelling, cephalea, and trigeminal and facial nerve paralysis [3].…”

“…However, the main factor is uncontrolled diabetes, which is present in 60–80% of mucormycosis cases [ 5 ]. Hyperglycemia coupled with low serum pH (<7′35) affects the phagocytic effect of macrophages and the chemotactic and oxidative response of neutrophils, thus decreasing host defense against mucormycosis [ 9 ].…”

“…Currently, as the number of people undergoing treatment with chemotherapy or immunotherapy increases, this factor is becoming more important [ 10 ]. Furthermore, it has also been observed that people with a history of severe COVID-19 are more vulnerable to infection [ 9 ].…”

“…The rhinocerebral form is the most common, as well as the most important for dentists, due to the oral manifestations it can present ( Figure 1 ). These are mainly caused by the direct spread of the infection from the sinus to the hard palate, thus causing sudden tooth mobility, perforation of the hard palate, pus secretion, painful necrotic ulcerations, gingival thickening, and halitosis [ 3 , 9 ].…”