Dr. Bhavik Miyani, Resident Doctor in Department of Oral & Maxillofacial Surgery, Narsinhbhai Patel Dental College & Hospital, Visnagar.

1. CASE PRESENTATION OF
ULCER
PRESENTED BY,
DR. BHAVIK MIYANI,
SECOND YEAR PG, OMFS,
NPDCH, VISNAGAR

2. CONTENTS
 Case Report
 Discussion
 Conclusion
 References

3. CASE REPORT
NAME :- Somabhai Babubhai Sharma
AGE/SEX :- 62 Years/ Male
OCCUPATION :- Farmer
ADDRESS :- Vijapur
CONTACT NO :- 7284876547
OPD NO. :- 44051-G.

4. CHIEF COMPLAINT
 Patient complaint of ulcer and
pain in palate region since 15
days.

5. HISTORY OF PRESENT ILLNESS
 Patient was relatively asymptomatic before 15 days. Then he
noticed ulcer on palate region when he visited private dental clinic at
vijapur.
 Then he noticed pain in same region which has referred to upper lip
region.
 Pain was mild, continuous, dull aching type that was aggravated by
taking food but not relieved by taking medications.
 Then pain became severe, continuous and sharp shooting type and
made patient to visit a private dental clinic but no treatment given.
 Then patient noticed heaviness in right maxillary sinus region and

6.  PAST MEDICAL HISTORY :-
- Patient is having Diabetes Mellitus since 13 years and on medication
for same.
- Patient is also having hypertension since 10 years and on medication
for same.
 PAST DENTAL HISTORY :-
- Patient had undergone uneventful extraction of 2 teeth before 20
years at private dental clinic.
 DRUG HISTORY :-
- No relevant drug allergy
 FAMILY HISTORY :-
- No relevant family history

7.  PERSONAL HISTORY :-
- Habits :- No harmful habits
- Diet :- Vegetarian
- Marital status :- Unmarried
- Brushing :- Once a day with toothbrush

8. GENERAL EXAMINATION
 Conscious
 Co-operative
 Well Oriented to time, place and person
 Built : Moderately built
 Nourishment :- Moderately nourished
 Gait :- Normal
 Vital signs :-
 Temperature: Afebrile
 Blood pressure: 130/84 mmhg
 Pulse rate: 88 beats/min
 Respiratory rate: 14 cycles/min

9. LOCAL EXAMINATION
1.EXTRA- ORAL
EXAMINATION :-
 Face :- No gross asymmetry
 Skin and soft tissue :- NAD
 Lips :- Competent
 Jaw movement :- Normal
 TMJ :- No clicking or crepitus while opening
or closing mouth
 Mouth Opening :- 38 mm

10. EXTRA-ORAL EXAMINATION

11. 2. INTRA-ORAL EXAMINATION :-
- Hard Tissue Examination -
- Present teeth- 11-17,21-25,27,31-35,41-45,47
- Carious teeth- 13-17,23,25,34,35
- Missing teeth- 26,36,37,46
- Mobility- Grade II- 11-13,21-23
- Soft Tissue Examination -
- Buccal Mucosa – NAD
- Labial Mucosa - NAD
- Palate – ULCER PRESENT ON ANTERIOR PALATE
- Gingiva – NAD

12. INTRA-ORAL EXAMINATION

13. INSPECTION
SIZE: 3*2 cm
SHAPE: Oval
NUMBER: 1
POSITION: Mid-palatal region in anterior
maxilla
EDGE: Punched-Out
FLOOR: Yellowish White
DISCHARGE: Pus Discharge
SURROUNDING AREA: Reddish- Inflamed
PALPATION
TENDERNESS: Non-tender on palpation
MARGIN: Irregular
EDGE: Punched-Out
BASE: Not Fixed to underlying bone
DEPTH: 2 mm
BLEEDING: Present
RELATION WITH DEEPER STRUCTURE:
Palatal bone

14. PROVISIONAL DIAGNOSIS
 Non Healing Ulcer on palate

15. DIFFERENTIAL DIAGNOSIS
1. Mucormycosis of palate
2. Osteomyelitis of maxilla
3. Primary Mucormycosis of maxillary sinus
leading to osteomyelitis of maxilla.

16. INVESTIGATIONS
1. Blood Profile
2. OPG & PNS view
3. Culture & Sensitivity of Pus
4. Biopsy of Lesion
5. CT Scan
6. MRI of Brain

17. BLOOD PROFILE

18. HBA1C ESTIMATION

19. OPG

20. PNS VIEW

21. CULTURE & SENSITIVITY

22. HISTOPATHOLOGY REPORT

23. CT SCAN

25. MRI OF BRAIN

26. FINAL DIAGNOSIS
Mucormycosis of Maxilla POSITIVE FINDINGS
AGE of the patient
Immunocompromised Status
SITE of lesion
Non-tender Lesion
Pus Discharging Lesion
Heaviness on Maxillary Sinus
Erosive Lesion on CT Scan

27. TREATMENT PLAN
1. Cleaning & Resection type Debridement of Lesion
2. Removable Prosthesis- Obturator for maintaining
Functinons
3. Amphotericin B therapy- 1.0-1.5 mg/kg daily in 5%
Dextrose
4. Hyperbaric Oxygen Therapy
Pooja Aggarwal, Susmita Saxena, Vishal Bansal; Mucormycosis of maxillary sinus; JOMFP: Vol. 11
Issue 2 Jul-Dec 2007

28. TREATMENT DONE

29. DISCUSSION
• Mucormycosis is a rare fulminating opportunistic fungal
infection caused by a fungus of the order Mucorales.
• These fungi are ubiquitous, found throughout the world on
fruit and bread, in air and in soil, where they exist as
saprophytes.
• Although the fungi and spores of Mucorales show minimal
intrinsic pathogenicity towards normal persons, they can initiate
aggressive and fulminating infection in the
immunocompromised host.
• Mucormycosis is an uncommon frequently fatal fungal
infection, which rarely arises in otherwise healthy people.

30. CONT…
• An underlying disease, frequently diabetes mellitus, is
almost always present.
• It appears stereotypically in different anatomic sites
namely, paranasal, rhino-orbital, rhino-cerebral, cerebral,
pulmonary and gastrointestinal area and in the soft tissue
of the extremities.
• It can also appear as disseminated disease.
• Tissue invasion by the hyphae of mucormycosis must be
seen microscopically to establish the diagnosis, but culture
is required to identify the fungal species involved.

31. REVIEW OF LITERATURE

35. Thank you…