Invasive Rhinomaxillary Mucormycosis a case report

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  • Hello Sir,
    i need ur help and advise for my mom treatment for Mucormycosis
    currently treat is going in Jupiter hospital mumbai but still no major improvement .
    below medicine doctor are using for treatment
    injection :fungisome
    syrup:posaconazole
    i will be very very thankful to you yo hear any update from u
    please share ur contact details for mor discusion

    Regards
    Ayyub
       Reply 
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Invasive Rhinomaxillary Mucormycosis a case report

  1. 1. Invasive Rhinomaxillary Mucormycosis a case report Dr T Balasubramanian www.drtbalu.co.in
  2. 2. Clinical details <ul><ul><li>38 years old female patient </li></ul></ul><ul><ul><li>Known diabetic under poor control </li></ul></ul><ul><ul><li>C/o Ulcerative lesion right side of   </li></ul></ul><ul><li>       palate - 2 years </li></ul><ul><ul><li>De vitalization of upper premolars </li></ul></ul><ul><li>     and molars </li></ul>
  3. 3. On examination <ul><ul><li>Whitish mass seen within the right nasal cavity </li></ul></ul><ul><ul><li>Mass was cheesy and insensitive to touch </li></ul></ul><ul><ul><li>Floor of the right nasal cavity eroded </li></ul></ul><ul><ul><li>Foul smelling purulent discharge from right nasal cavity  </li></ul></ul><ul><ul><li>slough covered lesion seen on the right side of hard palate </li></ul></ul><ul><ul><li>Right upper premolars and molars appear insensitive / devitalized  </li></ul></ul>
  4. 4. Biopsy <ul><li>  </li></ul><ul><ul><li>  Was reported as necrotic tissue containing mucor mycosis </li></ul></ul><ul><ul><li>  The fungi are seen as large number of aseptate ribbon like hyphae with right / obtuse angle branching </li></ul></ul>
  5. 5. Imaging <ul><li>CT scan coronal cut (posterior) </li></ul><ul><li>of nose and paranasal sinuses </li></ul><ul><li>showing heterodense mass arising </li></ul><ul><li>from right maxillary sinus eroding </li></ul><ul><li>the medial wall of maxilla and  </li></ul><ul><li>presenting inside the nasal cavity. </li></ul><ul><li>The same mass could also be </li></ul><ul><li>seen eroding the right side of hard </li></ul><ul><li>palate. </li></ul>
  6. 6. Discussion <ul><ul><li>Two types of mucor mycosis infections occur in humans.  Superficial and visceral. </li></ul></ul><ul><ul><li>Superficial forms are seen in skin, nails and external ear. </li></ul></ul><ul><ul><li>Visceral form could be gastrointestinal, rhinocerebral, pulmonary and disseminated. </li></ul></ul><ul><ul><li>Rhinocerebral type is the most common of visceral types and are seen in diabetics and immune compromised individuals </li></ul></ul>
  7. 7. Rhinocerebral mucormycosis <ul><ul><li>Two types </li></ul></ul><ul><li>Type I - rhino orbital cerebral (fatal) </li></ul><ul><li>Type II - rhino maxillary form  (less dangerous) </li></ul>
  8. 8. Features of mucor infections <ul><ul><li>Affects commonly diabetics / immune compromised individuals </li></ul></ul><ul><ul><li>Predilection for involving blood vessels / nerves / lymphatics </li></ul></ul><ul><ul><li>Produces extensive tissue necrosis due to vascular compromise </li></ul></ul><ul><ul><li>Increased availability of micro nutrients like iron in diabetics increases the pathogenecity of these organism </li></ul></ul>
  9. 9. Management <ul><ul><li>Diabetic control </li></ul></ul><ul><ul><li>Wound debridement </li></ul></ul><ul><ul><li>Administration of antifungal agents like amphoteracin B </li></ul></ul>
  10. 10. Video clipping of partial maxillectomy <ul><li>  </li></ul>
  11. 11. Thank you

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