Management and Maxillofacial Rehabilitation of COVID 19 associated Mucormycosis
Keywords:COVID-19, Coronavirus Associated Mucormycosis, Mucorrmycosis, Maxillofacial Prosthesis, Obturator, Silicone Prosthesis
Objectives: To study and present a management protocol formulated to treat coronavirus disease-associated invasive
fungal sinusitis (mucormycosis) (CAM) and related defects. Methods: A prospective interventional study was conducted
at a tertiary care centre over three months, involving patients with mucormycosis of the paranasal sinuses suffering from
or having a history of Coronavirus Disease infection (COVID-19) who underwent debridement surgery. A protocol was
formulated incorporating all the departments involved in the management of post-COVID-19 Associated Mucormycosis
(CAM) patients. A separate protocol for early prosthetic rehabilitation was also developed. Results: Twenty patients
underwent surgical and medical intervention along with prosthetic rehabilitation for CAM. All of the patients were postCOVID-19 infected and had developed acute symptoms. The maxillary sinus was affected in all these patients and 25% of
the patients had involvement of the orbit along with the maxillary sinus. All patients had been administered steroids during
the treatment for COVID-19-associated illness. Infrastructure maxillectomy of the right side was done in 35% of patients,
bilateral maxillectomy was done in 30% of patients, and two patients underwent infrastructure maxillectomy and orbital
exenteration of the right side. Six patients received a surgical obturator inserted on the second-day post-maxillectomy, 8
patients received an intermediate obturator inserted on the 10th-12th day post-maxillectomy and 6 patients received a
silicone obturator inserted on the 14th-18th day after bilateral maxillectomy. Conclusions: Early management, prompt
treatment and post-operative comprehensive rehabilitation towards an optimum Quality of Life (QOL) can be achieved for
good prognosis in patients affected by CAM. The prosthetic rehabilitation protocol provided prosthesis earlier and faster
to the patients that improved their QOL.
Sharma D, Dayama A, Banerjee S, Bhandhari S, Chatterjee A, Chatterjee D. To study the role of absolute lymphocyte count and RDW in COVID-19 patients and their association with appearance of symptoms and severity. J Assoc Physicians India. 2020 Aug; 68(8):39-42. PMID: 32738839.
Available from: https://www.mohfw.gov.in
Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, Puri GD, Chakrabarti A, Agarwal R. Coronavirus disease (Covid-19) associated mucormycosis (cam): case report and systematic review of literature. Mycopathologia. 2021 May; 186(2):289-298. https://doi.org/10.1007/s11046- 021-00528-2 PMid:33544266 PMCid:PMC7862973
Nasir N, Farooqi J, Mahmood SF, Jabeen K. COVID19-associated pulmonary aspergillosis (CAPA) in patients admitted with severe COVID-19 pneumonia: An observational study from Pakistan. Mycoses. 2020 Aug;63(8):766-770. https://doi.org/10.1111/myc.13135 PMid:32585069 PMCid:PMC7361517
Available from: https://www.covid19treatmentguidelines. nih.gov/
Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med. 2021; 42:264.e5-264.e8 https://doi. org/10.1016/j.ajem.2020.09.032 PMid:32972795 PMCid: PMC7493738
Mekonnen ZK, Ashraf DC, Jankowski T, et al. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID19-Associated Acute Respiratory Distress Syndrome. Ophthalmic Plast Reconstr Surg. 2021; 37(2):e40-e80. https://doi.org/10.1097/IOP.0000000000001889 PMid:332 29953 PMCid:PMC7927902
Soman R, Sunavala A. Post COVID-19 Mucormycosis - from the Frying Pan into the Fire. J Assoc Physicians India. 2021 Jan; 69(1):13-14.
Hanley B et. al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe. 2020 Oct; 1 (6):e245-e253. https:// doi.org/10.1016/S2666-5247(20)30115-4 PMid:32844161
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India [published online ahead of print, 2021 May 21]. Diabetes Metab Syndr. 2021; 15(4):102146. https://doi.org/10.1016/j.dsx.2021.05.019 PMid:34192610 PMCid:PMC8137376
Mengji AK, Yaga US, Gollamudi N, Prakash B, Rajashekar E. Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature. Pan Afr Med J. 2016 Jan 26; 23:16. doi: 10.11604/pamj.2016.23.16.8394. https://doi. org/10.11604/pamj.2016.23.16.8394 PMid:27200123 PMCid:PMC4856500
Song G, Liang G, Liu W. Fungal Co-infections Associated with Global COVID-19 Pandemic: A Clinical and Diagnostic Perspective from China. Mycopathologia. 2020 Aug; 185(4):599-606. doi: 10.1007/s11046-020-00462-9. Epub 2020 Jul 31. https://doi.org/10.1007/s11046-020- 00462-9 PMid:32737747 PMCid:PMC7394275
Cornely OA et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019 Dec
19(12):e405-e421. doi: 10.1016/S1473-3099(19)30312-3. Epub 2019 Nov 5. https://doi.org/10.1016/S1473-3099(19)30312-3 PMid:31699664
Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol 2021; 1-6. https:// doi.org/10.1017/S0022215121000992 PMid:33827722 PM Cid:PMC8060545
Guideline for management of Mucormycosis in Covid - 19 patients. DGHS. Available from: https://dghs.gov.in/ WriteReadData/News/202105171119301555988Mucormy cosismanagementinCovid-19.pdf.
Deshpande SN, Bhat S, Sharma R, Singh S, Fernandes J. Prosthetic rehabilitation of face following naso-orbital mycosis. Indian J Plast Surg. 2006; 39(01):73-75. https:// doi.org/10.1055/s-0039-1700467
Dholam KP, Sadashiva KM, Bhirangi PP. Rehabilitation of large maxillary defect with two-piece maxillary obturators. J Can Res Ther. 2015; 11:664. https://doi.org/10.4103/0973-1482.140801 PMid:26458692
Mani UM, Mohamed K, Krishna Kumar A, Inbarajan A. A modified technique to fabricate a complete hollow obturator for bilateral maxillectomy in a patient with mucormycosisA technical case report. Spec Care Dentist. 2019; 1-7. https://doi.org/10.1111/scd.12423 PMid:31608482
S Naveen1, A Cicilia Subbulakshmi, S Babu Susai Raj, Ranganathan Rathinasamy, S Vikram, Sabitha Gokul Raj. Mucormycosis of the palate and its post-surgical management: A case report. Journal of International Oral Health. 2015; 7(12):134-137.
Shah RJ, Katyayan MK, Katyayan PA, Chauhan V. Prosthetic rehabilitation of acquired maxillary defects secondary to mucormycosis: Clinical cases. J Contemp Dent Pract 2014; 15(2):242-249. https://doi.org/10.5005/ jp-journals-10024-1522 PMid:25095851
Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2020 Sep; 12(9):e10726. DOI10.7759/cureus.10726. https://doi.org/10.7759/cureus.10726