Chronic Bi-Maxillary Osteomyelitis Caused by Actinomycetes in a Patient with Severe COVID-19 / Osteomyelitis bi-maxilar crónica causada por Actinomycetes en un paciente con COVID-19 severo

Abstract Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow- up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.

Resumen La osteomielitis se define como la inflamación del hueso medular, cortical o esponjoso, incluyendo nervios y vasos sanguíneos, causando necrosis y formación de secuestro óseo; esta condición es una patología rara, y las infecciones odontogénicas son consideradas como el factor causal más frecuente. En este caso, se muestra un paciente con osteomielitis bi-maxilar causada por Actinomyces spp, la cual empeoró por la infección de COVID-19 severo. El paciente fue sometido a una cirugía, maxilectomía bilateral total amplificada, a través de la técnica quirúrgica de Weber- Fergusson, y el uso prolongado de una combinación de antibióticos, logrando una buena recuperación. A los 2 años de seguimiento, el paciente no mostró evidencia clínica o imagenológica de la infección de osteomielitis. El presente caso muestra una interesante relación entre una infección rara y su asociación con COVID-19.

Mucormicosis maxilar asociado a COVID-19, tratamiento médico-quirúrgico y manejo multidisciplinario. Reporte de caso / Maxillary mucormycosis associated with COVID-19, medical-surgical treatment and multidisciplinary management. Case report

Resumen Introducción: Durante la actual pandemia de COVID-19 múltiples complicaciones se han desarrollado posterior a la enfermedad, dentro de las cuales se encuentran las infecciones fúngicas, como la mucormicosis, que puede resultar directamente de la infección por COVID-19 y/o como efecto secundario de los fármacos utilizados en su tratamiento. La mucormicosis es una infección causada por un grupo de hongos llamados mucormycetes; a nivel rinocerebral se presenta con celulitis facial, cefalea, proptosis, movilización del diente afectado y secreción nasal. Reporte de caso: Se presenta a un paciente femenino de 57 años con antecedente de neumonía grave por COVID-19 con posterior desarrollo de absceso periodontal que ameritó extracción del segundo molar superior derecho con posterior formación de fistula. Se toma TC de macizo facial donde se evidencia erosión ósea con pérdida de la morfología habitual y en pared anterior del seno maxilar derecho. Se realiza biopsia reportando tejido óseo con elementos micóticos (hifas aseptadas) morfológicamente compatibles con mucor sp. Se realizó tratamiento con anfotericina B y hemimaxilectomia derecha. Actualmente se encuentra en tratamiento con pozaconazol, y lavados quirúrgicos. Conclusión: La enfermedad de COVID-19 es una enfermedad muy común actualmente a nivel mundial, por lo que es importante identificar y llevar un seguimiento de aquellas personas con factores de riesgo para desarrollar mucormicosis; el diagnóstico y un plan de tratamiento temprano es fundamental para evitar complicaciones, las cuales pueden originar un desenlace fatal.

Abstract Introduction: During the current pandemic of COVID-19 multiple complications have developed after the disease, among which are fungal infections, such as mucormycosis, which can result directly from COVID-19 infection and/or as a side effect of the drugs used in its treatment. Mucormycosis is an infection caused by a group of fungi called mucormycetes; at the rhinocerebral level it presents with facial cellulitis, headache, proptosis, mobilization of the affected tooth and nasal secretion. Case report: the following is a 57-year-old female patient with a history of severe pneumonia due to COVID-19 with subsequent development of periodontal abscess that merited extraction of the upper right second molar with subsequent fistula formation. The patient started an infection with the presence of purulent secretion in the extraction area of the right molar. A CT scan of the facial mass was taken showing bone erosion with loss of the usual morphology in the right upper maxillary bone and anterior wall of the right maxillary sinus, as well as a biopsy of the right maxilla reporting bone tissue with mycotic elements (aseptates hyphae) morphologically compatible with mucor sp. Treatment with amphotericin B and right hemimaxillectomy was performed. She is currently being treated with pozaconazole and surgical washings. Conclusion: COVID-19 disease is currently a very common disease worldwide, so it is important to identify and follow up those people with risk factors for developing mucormycosis; early diagnosis and treatment plan is essential to avoid complications, which can lead to a fatal outcome.

The outcome of transnasal endoscopic total maxillectomy in the treatment of sinonasal adenoid cystic carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients（30%） were positive. The median time of follow-up was 38 months（6 to 85 months）. Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin（P=0.018）, recurrence（P=0.006） and distant metastasis（P=0.04）. Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.

Maxillary Schwannoma – A Rare Case Report

Background: Schwannoma or neurilemmoma are a type of nerve sheath tumors. Most of the literature, reports of schwan- noma in the head and neck involve tongue. Intraosseous schwannomas account to about less than 1% with affliction to the mandible over maxilla. Very few cases of maxillary schwannomas have been reported till date. Case presentation: We present one such rare case of schwannoma involving the maxilla extending till the nasal cavity in a 35 years old male. Wide excision of the lesion with hemi-maxillectomy of the right side was done using modified Weber–Fergusson approach (Dieffenbach’s extension). The patient’s postoperative recovery was uneventful without recurrence when followed up till 2 years. Conclusion: Though schwannoma of the Head and neck region are rare, they should be considered as a differential diagnosis of unilateral slow growing mass in the head and neck region, particularly in an adult.

Angiosarcoma de cavidad nasal: reporte de caso y revisión de literatura

Los tumores malignos de cavidad nasal y cavidades paranasales son poco frecuentes y sus síntomas de presentación suelen ser unilaterales e inespecíficos; éstos incluyen: epistaxis, rinorrea y obstrucción nasal. Encontramos una amplia variedad histológica de tumores, entre ellos tenemos el angiosarcoma nasal, que es considerado una rareza y el diagnóstico definitivo lo da la confirmación anatomopatológica complementado con estudios inmunohistoquímicos. Su modalidad de tratamiento incluye múltiples opciones, pero la cirugía radical temprana con márgenes negativos asociado a radioterapia adyuvante, ofrece el mejor pronóstico. Se presenta a un paciente adulto masculino con un angiosarcoma nasal izquierdo que fue detectado de forma precoz y se manejó con cirugía radical y radioterapia.

Malignant tumors of the nasal cavity and paranasal cavities are rare, while presenting symptoms are usually unilateral and nonspecific like, epistaxis, rhinorrhea, and nasal obstruction. There are many histological varieties of tumors, among them we have nasal angiosarcoma, which is considered a rarity pathology. The definitive diagnosis is given by biopsy confirmation complemented with immunohistochemical studies. Its treatment modality includes multiple options, but early radical surgery with negative margins associated with adjuvant radiotherapy offers the best prognosis. We present a male adult patient with a left nasal angiosarcoma that was detected early and managed with radical surgery and radiotherapy.

Sinonasal Mucormycosis in a Diabetic - Case Report

Background : Mucormycosis is one of the rapidly progressing and lethal form of fungal infection which involves the nose and paranasal sinuses of the head and the neck regions. It manifests as rhinocerebral, sinonasal, pulmonary, gastrointestinal, cutaneous or disseminated form. The underlying conditions can influence clinical presentation and often delay diagnosis, with resultant poor outcomes. Objective: To present and discuss the case of a diabetic patient with sinonasal mucormycosis presented with facial pain and discolouration of right side of nose and face due to mucormycosis. Case report: A 23 years old female patient presented to emergency with uncontrolled blood sugars, pain and swelling over right side of face and blackish discolouration of right side of nose. On examination, there was bluish black discolouration of skin over right side of dorsum of nose and right ala of nose and right nasal vestibule. Sinus CT scan showed features suggestive of fungal sinusitis. Mucormycosis was suspected, confirmed with biopsy and surgical debridement and medial maxillectomy done. Intravenous amphotericin B was administered for 21 days. The patient was followed up regularly, the disease appearing to be resolved. Conclusion: Mucormycosis is a rapidly progressive fatal infection mostly reported in immune-compromised individuals. Emergency multidisciplinary treatment for control of blood sugars, surgical debridement and effective antifungal medications gives better clinical outcome.

Management of recurrent polymorphous low grade adenocarcinoma: a case report / Manejo de adenocarcinoma polimorfo recorrente de baixo grau: relato de caso

The Polymorphous Low Grade Adenocarcinoma (PLGA) is a common minor salivary gland carcinoma. It mostly affects the buccal mucosa and retromolar region, but the palate is an unusual site. As the carcinoma is low grade the recurrence is also uncommon. Our patient had a PLGA initially in the palate which was treated initially through surgical management but had a recurrence after four years. Hence we planned a partial maxillectomy along with level I nodes. Post-operatively follow-up is successful till date. So the management of a recurrent PLGA through careful surgery and post-operative follow ­up with prosthetic rehabilitation is discussed in this article... (AU)

Clinicopathologic profile of patients with maxillofacial tumors in a tertiary level government institution

RATIONALE@#Bone tumors of the head and neck region are rare. Their occurrence, biologic behavior, and management can cause significant personal, social, behavioral and economic ramifications. The aim of this study was to describe the clinicopathologic profile of patients with maxillofacial tumors in a tertiary level government hospital. @*METHODS@#This was a retrospective, descriptive study over a five-year period (January 2013 to December 2018).@*RESULTS@#A total of 256 patients was included in the study, with females accounting for 53.5% and males for 46.5%. The mean age of presentation was 37.4 years with a range of 18-80 years. The mean age of patients with benign tumors was 36.1 years, while those with malignant tumors was higher at 61.8 years. Majority of the tumors involved the mandible. Ameloblastoma and dentigerous cysts were the most prevalent benign odontogenic tumors while squamous cell cancer was the most common malignancy. Radical surgery with composite reconstruction was done in malignant cases to ensure adequate pathologic margins, while a more conservative tissue-sparing approach was done for benign cases.@*CONCLUSION@#Management of maxillofacial tumors remains a challenge because of its relative anatomic location and locally-advanced state upon detection. Identifying these tumors at an early stage ensures adequate resection with minimal functional and aesthetic loss. The low morbidity and mortality rates reported in this study emphasizes the role of the multidisciplinary team approach, surgical experience and comprehensive perioperative care in the management of bone tumors in the head and neck.

Fabrication of closed hollow obturator for hard palate defect patient undergone maxillectomy / 대한치과보철학회지

Maxillectomy is performed to remove the tumor in the palate, maxillary sinus, buccal mucosa or nasal cavity. The resection range depends on the size and the extent of the tumor and it affects speech production or cause nasal regurgitation during feeding. Obturator can occlude an opening such as an oro-nasal fistula and protect the defect area. Successful reconstrucion of the patient's oral cavity who have gone over the maxillectomy is a difficult task. The condition and number of teeth, the remaining support area, and the extent of the defect area have a great influence on manufacturing the obturator. If these factors are disadvantageous, the prognosis of the prosthesis is uncertain. The final obturator must have a sufficient retention in the patient's oral cavity and must not irritate the surrounding tissue and support area where the resection was performed.In this case, a 55 year old female went through the maxillectomy and the only 3 teeth remained. And the retention of the maxillary prosthesis seems to be poor. So that, we fabricated the closed hollow obturator which has reduced weight compared to the conventional obturator. Consequently the closed hollow obturator can give better sealing and the adaptation.

Surgical retention for immediate obturator in maxillectomy patients

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.

Obturadores de paladar en el sistema respiratorio-fono-articular. Caso clínico / Palatal obturators in the respiratory-phono-articular system. Clinical case

RESUMEN Los maxilares son los huesos que proveen soporte a la base del cráneo y son esenciales en la caja de resonancia para la producción de la voz, así como el sostén de los músculos del paladar blando por lo que los defectos creados en estas estructuras anatómicas tras la resección de neoplasias o traumatismos, dan como consecuencia la pérdida de algunas funciones como la fonación, deglución, masticación, respiración, estética y la pérdida de la autoestima. El paladar blando es un elemento esencial en los movimientos de la válvula velofaríngea que regula y dirige la transmisión de la energía del sonido y la presión de aire en las cavidades oral y nasal durante el habla, las resecciones de esta estructura involucran un reto en la rehabilitación.

ABSTRACT The maxillaries are the bones that provide support to the base of the skull and are essential in the sounding board for the voice production as well as the support of the muscles of the soft palate so that defects in these anatomical structures created after resection of tumors or trauma, they result in the loss of some features like phonation, swallowing, chewing, breathing, aesthetics and loss of self esteem. The soft palate is an essential element in velopharyngeal movements regulating valve and directs the transmission of sound energy and the air pressure in the oral and nasal cavities during speech, resections that this structure involves a challenge rehabilitation.

Prosthetic rehabilitation using an obturator in a fully edentulous patient who had partial maxillectomy

Prosthetic rehabilitation of an edentulous patient who has a maxillary defect is difficult to achieve for many clinicians. The maxillary defect causes leakage of air during pronunciation and compromises denture stability, support and retention by reducing denture-bearing area and breaking peripheral seal. In these patients, the sizes and shapes of defects are very important factors which attribute to prognosis of maxillary obturators. This case report shows the prosthetic rehabilitation of the patient who had maxillectomy on the right maxillary sinus because of squamous cell carcinoma. The patient had a stepwise treatment protocol which started with pre-operative dental examination and followed by surgical, interim and definitive obturation phase. In this case, an acceptable level of retention could be obtained due to well-defined static defects and the preserved premaxillae and the patient was satisfied with the result of the treatment in the aspect of function and esthetics.

Reconstrucción facial con colgajo de músculo temporal posexenteración orbitaria / Facial reconstructon with temporalis muscle fap afer orbital exenteraton

La exenteración orbitaria y la maxilectomía son cirugías que conducen a pérdidas funcionales y estéticas. Representan un reto reconstructivo. El colgajo de músculo temporal es un colgajo versátl y seguro en la cirugía plástica. Fue descripto por primera vez por Lentz en 1895. En 1898, Golovine describió este colgajo para la reconstrucción de un defecto posexenteración de órbita y, en 1948, lo hizo Campbell con respecto a una reconstrucción posmaxilectomía6. El objetivo es presentar nuestra experiencia con el uso de colgajo de músculo temporal pediculado, como una alternativa válida en reconstrucciones posmaxilectomía y exenteración orbitaria asociada a carcinoma de células escamosas. Se presentan dos casos de tumores gigantes por carcinomas de células escamosas en órbita y malar con compromiso periorbital, reconstruidos con colgajo de músculo temporal pediculado, asociado a un injerto de piel, en dos instituciones públicas en la ciudad de Mendoza, República Argentina. El estudio incluyó dos pacientes de sexo femenino, de 71 y 58 años de edad. Ambos tumores comprometan tanto la región orbitaria como la periorbitaria y malar. La anatomía patológica arrojó como resultado carcinoma de células escamosas. La reconstrucción se logró con colgajo de músculo temporal pediculado e injerto de piel. Las complicaciones informadas en la literatura, como la necrosis del colgajo o el injerto, fistulas orbitales, o parálisis facial7, no se registraron en nuestros casos. A la primera paciente se le ofreció radioterapia posoperatoria por presentar resección R1. En la segunda paciente la resección fue R0. El uso de colgajo de músculo temporal pediculado más injerto de piel es una opción importante para la reconstrucción facial posmaxilectomía asociada a exenteración orbitaria. Permite cubierta y relleno de la zona, con resultados estéticos y de reparación aceptables, y es una alternativa válida al uso de colgajos libres, con una curva de aprendizaje más baja y una tasa de complicaciones aceptables.

Orbital exenteraton and maxillectomy result in functonal and aesthetic loss, representing a challenge for reconstructive surgeons. The temporalis muscle fap is a versatle and safe opton for plastic surgery. It was frst described by Lentz in 1895. In 1898 Golovine described this fap for the reconstructon of the defect afer exenteraton of the orbit. In 1948 Campbell described itis use for the reconstructon of a defect afer a maxillectomy6. Our objective was to report the use of pedicle temporalis fap for post-maxillectomy reconstructon and associated orbital exenteraton due to squamous cell carcinoma. We report on two cases of giant tumors due to squamous cell carcinomas of the skin with orbital, periorbital and malar involvement. Reconstructon was done with a temporalis fap associated with a skin graf. The study included two female patentis, aged 71 and 58 years, respectively, afected by a tumor involving he orbital, periorbital and malar regions. Histology confirmed squamous cell carcinoma. Reconstructon was done with a temporal pedicle and a skin graf. No morbidity or mortality occurred. The frst patent underwent radiotherapy postoperatively, as the resecton was R1. Resecton for the second patent was R0. Pediculated temporal muscle fap plus a skin graf is a valid opton for post-maxillectomy reconstructon with associated orbital exenteraton. It allows covering and flling of the area, with acceptable aesthetic and repair Results, posing an alternative to the use of free faps with a lower lear-ning curve and a lower complicaton rate.

Prosthetic rehabilitation of a patient with near total maxillectomy using a hollow bulb obturator: a case report

Aim: To prosthetically rehabilitate maxillary defect in a patient with near total maxillectomy using hollow bulb obturator. Case description: Authors report a case of 64-year-old male patient with near total maxillectomy with respect to the left side who was referred for the prosthetic rehabilitation. Conclusions: The hollow bulb definitive obturator prosthesis rehabilitated the patient in terms of masticatory function, phonetics and esthetics. The hollow bulb design ensured patient comfort due to its decreased weight.

Maxillary resection for cancer, zygomatic implants insertion, and palatal repair as single-stage procedure: report of three cases / 대한악안면성형재건외과학회지

BACKGROUND: Oronasal/antral communication, loss of teeth and/or tooth-supporting bone, and facial contour deformity may occur as a consequence of maxillectomy for cancer. As a result, speaking, chewing, swallowing, and appearance are variably affected. The restoration is focused on rebuilding the oronasal wall, using either flaps (local or free) for primary closure, either prosthetic obturator. Postoperative radiotherapy surely postpones every dental procedure aimed to set fixed devices, often makes it difficult and risky, even unfeasible. Regular prosthesis, tooth-bearing obturator, and endosseous implants (in native and/or transplanted bone) are used in order to complete dental rehabilitation. Zygomatic implantology (ZI) is a valid, usually delayed, multi-staged procedure, either after having primarily closed the oronasal/antral communication or after left it untreated or amended with obturator. The present paper is an early report of a relatively new, one-stage approach for rehabilitation of patients after tumour resection, with palatal repair with loco-regional flaps and zygomatic implant insertion: supposed advantages are concentration of surgical procedures, reduced time of rehabilitation, and lowered patient discomfort. CASES PRESENTATION: We report three patients who underwent alveolo-maxillary resection for cancer and had the resulting oroantral communication directly closed with loco-regional flaps. Simultaneous zygomatic implant insertion was added, in view of granting the optimal dental rehabilitation. CONCLUSIONS: All surgical procedures were successful in terms of oroantral separation and implant survival. One patient had the fixed dental restoration just after 3 months, and the others had to receive postoperative radiotherapy; thus, rehabilitation timing was longer, as expected. We think this approach could improve the outcome in selected patients.

Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth

OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.

Maxillofacial rehabilitation of hemi-maxillectomy patient using a closed hollow bulb obturator fabricated by one-step polymerization technique: a clinical report / 대한치과보철학회지

The maxillary defects lead to anatomical and functional deformity of the maxillofacial region. As far as functions are concerned, such defects can produce difficulty in speech, mastication, and deglutition. Obturator prostheses play a very important role in functional recovery for post-maxillectomy patients. To achieve rigidity of the obturator, appropriate retention should be given, and the weight of the prosthesis be reduced. There are two types of hollow bulb obturator: open and closed. A closed type has many advantages. Nevertheless, some problems, including complexity of fabrication and water leakage into the bulb, have the closed hollow obturator not be widely used. The one-step polymerization technique described in this case overcomes the shortcomings by easily constructing a small hollow bulb with two thermoplastic resin sheets.

A Immediate Orbital Floor Reconstruction after Suprastructure Maxillectomy

Orbital wall Reconstruction After Maxillectomy For Maxillary Malignancies Is Very Challenging For Surgeons. Preservation Of The Orbit Is A Current Trend In This Procedure In Order To Increase The Quality Of Life Of Patients. If The Patients Have Not Achieved A Proper And Adequate Rigid Frame Of The Orbital Floor After Maxillectomy, They Can Suffer From Enophthalmos, Diplopia, And/Or Decreased Vision. The Authors Report One Case Of Immediate Orbital Floor Reconstruction Using A Bioreabsorbable Panel And Titanium Mesh After Successful Suprastructure Maxillectomy. The Functional And Plastic Outcomes Of The Orbit Were Excellent 4 Years After Surgery, Without Complications or recurrence.

Implant assisted obturator in patient after maxillectomy: a case report

Reconstruction of the maxillectomy with an obturator is to restore masticatory, swallowing, phonetic and esthetic problems. Stress created by lateral forces is minimized by the proper selection of an occlusal scheme, elimination of premature occlusal contacts, and wide distribution of supporting area. It should be considered that properly designed retainers reduce the stresses transmitted to the abutment while the obturator is in function. The following clinical report presents palatal obturator treatment with implant assisted removable partial denture (IARPD) design that restores normal function and esthetics in patients who experienced maxillectomy and dental implant failure.

Maxillofacial rehabilitation of adenoid cystic carcinoma patient using full mouth fixed implant and pharyngeal obturator: a clinical report

Rehabilitation of maxillectomy patients is challenging. The maxillary defects need to functional restoration because of mastication, speech, swallowing problems. The goal of making obturator is to restore maxillary defects and give patients comfortable, esthetic prosthesis. This case report presents acquired masticatory and esthetic results and improved retention resulting from the pharyngeal obturator prosthesis using implant.