World Journal of Dentistry

Register      Login

VOLUME 12 , ISSUE 5 ( September-October, 2021 ) > List of Articles

CASE REPORT

COVID-19-related Mucormycotic Osteomyelitis of the Maxilla: A Case Report of Findings, Surgical Management and Post-surgical Rehabilitation

Yaseer Arafat, Yenugula Naren Kumar, Kamini Bharani, Thodur M Balaji, Saranya Varadarajan, Thirumal Raj, Shankargouda Patil

Keywords : COVID-19, Maxillary osteomyelitis, Mucormycosis

Citation Information : Arafat Y, Kumar YN, Bharani K, Balaji TM, Varadarajan S, Raj T, Patil S. COVID-19-related Mucormycotic Osteomyelitis of the Maxilla: A Case Report of Findings, Surgical Management and Post-surgical Rehabilitation. World J Dent 2021; 12 (5):423-426.

DOI: 10.5005/jp-journals-10015-1864

License: CC BY-NC 4.0

Published Online: 29-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: To report a case of surgical management and postsurgical rehabilitation COVID-19-related mucormycotic osteomyelitis of the maxilla. Background: Patients with the SARS-CoV-2 infection, also termed the COVID-19 illness, have been found to be afflicted with other associated bacterial and fungal diseases which have been termed as co-infections. In this regard, mucormycosis, a fungal infection, has been found to occur in these patients especially with a lowered immune response and has been found to cause osteomyelitis of the jaw bones. Case description: We present a case of mucormycosis in a COVID-19-affected patient that occurred in August 2020 denoted the first wave of disease in India, causing extensive osteomyelitis of the left maxilla. The patient presented clinically with odontalgia and tooth mobility in the upper anterior region. Clinical examination revealed the presence of abscesses in the attached gingiva in relation to tooth numbers 13,12, 11, 22, 23,24 and 25. A deep horizontal cleft was observed in the mucogingival junction in relation to 23 discharging pus. Computed tomography (CT) imaging revealed a diffuse radiolucency extending from the alveolar ridge of the upper anterior teeth to the left maxillary sinus, breaking the floor of the sinus. We have performed extensive medical and surgical management of this patient including postoperative prosthetic rehabilitation which is documented in the present case report. Clinical significance: Our observation of maxillary osteomyelitis secondary to mucormycosis in the first COVID wave in India makes our case extremely rare and important as this highlights that COVID-19 complications were significant but under-evaluated in the first wave of the disease.


PDF Share
  1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020;91(1):157–160. DOI: 10.23750/abm.v91i1.9397.
  2. Walls AC, Park Y-J, Tortorici MA, et al. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell 2020;181(2):281–292.e6. DOI: 10.1016/j.cell.2020.02.058.
  3. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8(5):475–481. DOI: 10.1016/S2213-2600(20)30079-5.
  4. Mishra SK, Tripathi T. One year update on the COVID-19 pandemic: where are we now? Acta Trop 2021;214:105778. DOI: 10.1016/j.actatropica.2020.105778.
  5. Chakraborty C, Sharma AR, Bhattacharya M, et al. The current second wave and COVID-19 vaccination status in India. Brain Behav Immun 2021;96:1–4. DOI: 10.1016/j.bbi.2021.05.018.
  6. Gao Y, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy 2021;76(2):428–455. DOI: 10.1111/all.14657.
  7. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev [Internet] 2000;13(2):236–301. Available from: https://journals.asm.org/doi/10.1128/CMR.13.2.236.
  8. Banerjee M, Pal R, Bhadada SK. Intercepting the deadly trinity of mucormycosis, diabetes and COVID-19 in India. Postgrad Med J [Internet] 2021. DOI: 10.1136/postgradmedj-2021-140537postgradmedj-2021-140537. Available from: https://pmj.bmj.com/lookup/doi/10.1136/postgradmedj-2021-140537.
  9. Mallis A, Mastronikolis SN, Naxakis SS, et al. Rhinocerebral mucormycosis: an update. Eur Rev Med Pharmacol Sci 2010;14(11):987–992.
  10. Doni B, Thotappa L, Peerapur B, et al. Sequence of oral manifestations in rhino-maxillary mucormycosis. Indian J Dent Res [Internet] 2011;22(2):331. DOI: 10.4103/0970-9290.84313Available from: http://www.ijdr.in/text.asp?2011/22/2/331/84313.
  11. Selvamani M, Donoghue M, Bharani S, et al. Mucormycosis causing maxillary osteomyelitis. J Nat Sci Biol Med [Internet] 2015;6(2):456. DOI: 10.4103/0976-9668.160039Available from: http://www.jnsbm.org/text.asp?2015/6/2/456/160039.
  12. Kwak E-J, Kim D-J, Nam W, et al. Mucormycosis in the jaw: a report of 2 cases and literature review. Oral Health Prev Dent 2020;18(1):1011–1016. DOI: 10.3290/j.ohpd.a45522.
  13. Pal R, Singh B, Bhadada SK, et al. COVID-19-associated mucormycosis: an updated systematic review of literature. Mycoses [Internet] 2021. myc.13338. Available from: https://onlinelibrary.wiley.com/doi/10.1111/myc.13338.
  14. Ibrahim AS, Kontoyiannis DP. Update on mucormycosis pathogenesis. Curr Opin Infect Dis [Internet] 2013;26(6):508–515. DOI: 10.1097/QCO.0000000000000008Available from: http://journals.lww.com/00001432-201312000-00004.
  15. Singh AK, Singh R, Joshi SR, et al. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev [Internet] 2021;15(4):102146. DOI: 10.1016/j.dsx.2021.05.019Available from: https://linkinghub.elsevier.com/retrieve/pii/S1871402121001570.
  16. Liang Y, Chen X, Wang J, et al. Oral posaconazole and bronchoscopy as a treatment for pulmonary mucormycosis in pediatric acute lymphoblastic leukemia patient. Medicine (Baltimore) [Internet] 2021;100(6):e24630. Available from: https://journals.lww.com/10.1097/MD.0000000000024630.
  17. van Burik J-AH, Hare RS, Solomon HF, et al. Posaconazole is effective as salvage therapy in zygomycosis: a retrospective summary of 91 cases. Clin Infect Dis an Off Publ Infect Dis Soc Am 2006;42(7):e61–e65. DOI: 10.1086/500212.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.