Reconstruction of Head and Neck Mucormycosis: A Literature Review and Own Experience in Immediate Reconstruction

Abstract

Background Mucormycosis is a rare invasive and fatal fungal infection. A prompt diagnosis is the most critical aspect for an improved patient outcome. Along with antifungal therapy, radical surgical debridement must be done expeditiously to eradicate this fungus. In this article, we evaluated the feasibility of immediate reconstruction after surgical debridement. Methods A retrospective study was performed at Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de México, Mexico, between June 2017 and June 2018. Five patients, three males and two females, with a mean age of 39 years were presented in addition to a literature review based on MEDLINE, Google Scholar, PubMed Central, and Embase platforms until June 2018. Results From our presented series, all five flaps survived and showed no evidence of mucormycosis recurrence or flap loss. In the literature review, we collected 16 cases from 14 different publications of individuals with head and neck mucormycosis. Reconstruction was made with a free (12 cases) or pedicled flap (four cases). Eleven males and five females with a mean patient age of 33.0 years were studied. Only two authors described an early or immediate reconstruction. The average time of the delayed reconstruction after surgical debridement was 16.7 weeks. Conclusion After aggressive surgical resection, immediate reconstruction can be done safely based on clinical criteria and as long as there is no evidence of hyphae invasion on wound edges in the intraoperative pathology examination.

Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes

“…Zygomatic implants have emerged as a successful entity in such cases [206]. Various authors have reported use of osteo-cutaneous free flaps like free fibula flap, radial forearm, and deep circumflex iliac artery flap with successful uptake [203,207].…”

“…Facial, nasal, and oral deformities are known complications of the surgical management of ROCM [218]. These resultant defects require reconstruction in the form of loco-regional or distant flaps with or without prosthesis for dental and palatal defects [207].…”

Mucormycosis Management in COVID-19 Era: Is Immediate Surgical Debridement and Reconstruction the Answer?

“…20 Some authors have also reported multiple debridement sessions to gain disease control and delayed reconstruction. 21,22 In comparison to most of the studies reported in literature in which reconstructions of almost (88%) all published head and neck mucormycosis cases are performed secondarily, 23 in our study, we postulate extensive wide tissue resection and immediate reconstruction as an adequate treatment option for patients with ROC mucormycosis to decrease further operations and improve recovery. Even though an additional revision procedure is required to restore cosmesis, autologous reconstruction ensures adequate coverage of the defect, all the while supporting the facial contour.…”

Single-Stage Reconstruction of Maxillectomy and Midfacial Defects in Cases of Covid Associated Mucormycosis

“…It is vital to provide these patients with a good outcome in terms of survival, quality of life, speech, feeding and aesthetics [7]. The appropriate technique for reconstruction depends primarily on the type of anatomical defect.…”