Subperiosteal inferior maxillectomy in mucormycosis patients: case series

Abstract

Objective Mucormycosis is a rapidly progressive and fulminant fungal infection mainly affecting the nose and paranasal sinuses and often requiring aggressive surgical debridement, which commonly includes inferior maxillectomy. Conventional inferior maxillectomy involves removal of the bony hard palate and its mucoperiosteum. This can lead to formation of an oroantral fistula and thereby increase the morbidity in these patients leading to prolonged rehabilitation. Subperiosteal inferior maxillectomy involves sparing of the uninvolved mucoperiosteum of the hard palate. This flap is used for closure of the oroantral fistula, which preserves the functional capabilities of the patient, such as speech, mastication and deglutination. Method This case series describes the experience of using the technique of mucosa-preserving subperiosteal inferior maxillectomy in five patients with mucormycosis. Results With the technique used in this study, complete oronasal separation was achieved in all six patients. The overall surgery time was also decreased when compared with free tissue transfer. Patients also did not have to bear the weight of prosthesis. Conclusion Mucoperiosteal palatal flap-preserving subperiosteal inferior maxillectomy is an excellent approach for all patients with mucormycosis and healthy palatal mucosa.

Appropriate Total Rehabilitation in the Bilateral Maxillectomy Defected Diabetic Patient Secondary to Aggressive Aspergillosis

“…By preserving the palatal soft tissue, oronasal separation and the greater palatine artery for better vascularization can be maintained. As mentioned by Wadhwa et al, 22 this technique should be considered in patients with aggressive fungal infection, in contrast to patients with malignancy, where adequate resection margins are crucial. This technique not only result in better aesthetic and functional outcomes, but also can reduce the need for microvascular reconstruction surgery, and further prosthodontic rehabilitation can be considered after routine follow-up.…”