Oral health-related quality of life after rehabilitation with maxillary obturators: A comparison of patients with maxillectomy defects associated with cancer and post-COVID-19 mucormycosis.

STATEMENT OF PROBLEM: Maxillectomy alters function and esthetics, negatively affecting oral health-related quality of life (OHRQoL). OHRQoL has been assessed after prosthetic rehabilitation in patients with maxillectomy associated with cancer. However, OHRQoL studies after prosthetic rehabilitation in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis are lacking. PURPOSE: The purpose of this clinical study was to compare OHRQoL before and after rehabilitation with maxillary obturators in patients with maxillectomy defects associated with cancer and post COVID-19 mucormycosis. MATERIAL AND METHODS: The study was conducted at 2 centers. A total of 47 participants who underwent maxillectomy because of cancer were included from the first center, and 32 participants who underwent maxillectomy because of post COVID-19 associated mucormycosis of the maxilla were included from the second center. Participants were asked to rate their dental problems on a Likert scale using Oral Health Impact Profile-14 (OHIP-14) before and after prosthodontic rehabilitation. The difference between scores among groups for each item and overall score was compared by using the Wilcoxon Rank-Sum test (α=.05). A linear mixed-effects model was fitted to account for the repeated measures within individuals. A random intercept for each participant was included to account for the within-subject correlation. RESULTS: An overall improvement in the OHRQoL of participants was found in both groups. The mean total OHIP-14 score for the cancer group decreased from 24.2 at the prerehabilitation stage (Pre-R) to 9.5 at the postrehabilitation stage (Post-R). The magnitude of improvement was higher for the post COVID-19 associated mucormycosis group with a reduction in the mean total OHIP-14 score of 52.0 (Pre-R) to 6.5 (Post-R). The mean change in OHIP-14 scores after rehabilitation was 15 (95% CI 10-19) in the cancer group but significantly larger at 45 (95% CI 41-49) in the mucormycosis group. The P value for the mean total OHIP-14 score at Pre-R was <.001 and at Post-R was.031. The interaction term between groups and time was significant, indicating different effects between groups with time. CONCLUSIONS: Comparison of the OHRQoL after rehabilitation with prostheses among patients with cancer and post COVID-19 associated mucormycosis showed that the OHRQoL scores, although much higher among patients with mucormycosis before rehabilitation (compared with patients with cancer), were almost similar after rehabilitation.

Oral manifestations, risk factors and management strategies of COVID-19 associated mucormycosis in tertiary care hospital.

Background: Mucormycosis (black fungus) is an aggressive, life-threatening infectious disease-causing infiltration and by destroying the surrounding bone and soft tissue through vascular thrombosis and subsequent tissue infarction that may reach the brain with fatal complications. Its outbreak has been assessed around the clock during the recent pandemic as post COVID-19 sequelae. Aims: To assess the risk factors, oral signs and symptoms, investigations, treatment and rehabilitation strategies amongst COVID-19 associated mucormycosis patients in a tertiary care hospital. Methods and Material: An observational, pilot study was carried out amongst 30 active or recent COVID-19 associated mucormycosis patients reporting in the Department of Dentistry of a tertiary care hospital in Bhopal over a period of 6 months. Statistical analysis was done using Kolmogorov-Smirnov test using the Statistical Package for Social Sciences, Version 16 software. Results: Study was done on 30 patients (80% males and 20% females) and their median age was 46 years. Predominant risk factor present was diabetes mellitus (90%) and steroid therapy (60%). Prime oral manifestations were toothache (90%), mobile teeth (83%), draining sinus (53%), palatal ulceration (43%) and para-sinusal pain (37%). Conclusions: Mucormycosis can cause serious oro-facial morbidity and mortality in COVID-19 patients. The current management strategy requires early diagnosis, prompt treatment and oral rehabilitation.

Maxillary defects due to COVID-19 associated mucormycosis: Impact on quality of life after rehabilitation with an obturator.

STATEMENT OF PROBLEM: Aggressive surgical debridement including maxillectomy in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis of the maxilla alters facial appearance, function, and an individual's overall quality of life (QOL). These patients require rehabilitation of defects with obturators to help them recover from esthetic and functional disabilities and regain near-normal quality of life. Because COVID-19 associated with mucormycosis is a newer entity, less is known about the quality of life of these patients after rehabilitation with obturators. Hence, the effects of COVID-19 associated with mucormycosis, treatment, and rehabilitation need to be evaluated to assess QOL. PURPOSE: The purpose of this clinical study was to assess the impact on QOL after rehabilitation with obturators for participants with COVID-19-associated mucormycosis who underwent maxillectomy. MATERIAL AND METHODS: Oral health impact profile-14 (OHIP-14) and obturator functioning scale (OFS) questionnaires were administered to 26 participants with COVID-19-associated mucormycosis of the maxilla who underwent maxillectomy and required rehabilitation with obturators. Questionnaire responses were received on numerical Likert scales of 0 to 4 for OHIP-14 and 1 to 5 for OFS. The repeated measures analysis of variance (ANOVA) with pairwise post hoc Bonferroni tests were used to evaluate and compare mean scores of OHIP-14 and OFS at different preoperative and postoperative stages (α=.05). RESULTS: A total of 26 participants who underwent maxillectomy were provided with obturators. A higher mean ±standard deviation OHIP score was observed before rehabilitation at T1 (51.0 ±9.6) followed by 1 week after fabrication of the surgical obturator at T2 (18.6 ±16.4), and 1 week after fabrication of the interim obturator at T3 (4.7 ±8.2). The lower mean scores ±standard deviation were seen 1 week after the fabrication of definitive obturators at T4 (2.9 ±7.2). Comparison of the scores at T1, T2, T3, and T4 found significant difference (P≤.001). Similarly, higher mean ±standard deviation OFS scores were seen 1 week after rehabilitation with surgical obturators at T2 (27.3 ±12.6) and at least 1 week after fabrication with definitive obturators at T4 (15.7 ±5.6). A comparison of the scores at T2, T3, and T4 found significant differences (P≤.001). CONCLUSIONS: Considerable improvement was seen in QOL with the fabrication of surgical obturators in participants who had received maxillectomy/debridement for mucormycosis. This improvement had a linear relationship with the time elapsed and the consecutive fitting of the obturators with healing.

Impact of Oral Rehabilitation on Patients with Head and Neck Cancer: Study of 100 Patients with Liverpool Oral Rehabilitation Questionnaire and the Oral Health Impact Profile.

Prosthodontic rehabilitation enables head and neck cancer patient to optimally restore function, thereby improving and enhancing the oral health related quality of life of cancer patients. The liverpool oral rehabilitation questionnaire (LORQ-v3) and oral health impact profile (OHIP) are specific tools that measure OHRQOL. Hundred patients with head and neck cancer were included in the study. Patients were asked to rate their experience of dental problems before fabrication of prosthesis and after 1 year using LORQv3 and OHIP-14. The responses were compared on Likert scale. There were extreme problems reported by head and neck cancer patients before dental rehabilitation. After 1 year of prosthetic rehabilitation, there was improvement noticed in all the domain of LORQ-v3 and OHIP-14. Complete compliance to the use of prosthetic appliances for 1 year study period was noted. For all the items of LORQ-v3 there was 10 to 38% improvement in function. OHIP-14 showed an 11 to 26% improvements in all the domains. Prosthetic rehabilitation contributed to an improvement of patients with head and neck cancer, in view of the decreased scores on the Likert scale after prosthetic treatment. The study of hundred patients with head and neck cancer showed that the oral health-related quality of life improved after prosthodontic rehabilitation.

Prosthetic Management of Hard Palate Perforation in a Child with Acute Lymphoblastic Leukemia.

Palatal perforation is an uncommon complication seen in children with acute lymphoblastic leukemia undergoing chemotherapy. This may impact basic functions, such as speech, swallowing, chewing, affecting the quality of life (QOL). Prosthetic rehabilitation of the palatal perforation with obturator can optimally restore function, thereby improving and enhancing the QOL of these patients.

Is palatal vault height a determinant for nasopharyngeal carcinoma: A hypothesis?

Although environmental and genetic factors are known for nasopharyngeal carcinoma, the present study is an attempt to provide a hypothesis behind the development of NPC with regards to the anatomical factor, the hypothesis being that patients with a deeper palatal vault tend to have a higher risk of developing nasopharyngeal cancers. The objective of this study was to find out the palatal vault height in patients with nasopharyngeal carcinoma and compare it with the palatal vault height in patients with oral carcinomas. The heights of the palatal vault of 20 consecutive patients with nasopharyngeal carcinoma and 20 patients with carcinoma of the oral cavity (except hard palate) as control were recorded. In addition, in patients with carcinoma of the nasopharynx the height of the palate on the CT scans was measured and correlation between these recordings were calculated. The palatal heights of the nasopharyngeal and oral cancer cohorts were compared using independent sample T test. A strong correlation was observed in the nasopharyngeal cancer cohort between the palatal height measured manually and the radiologically measured height on the CT scans (Pearson Correlation Coefficient - 0.633; p=0.003). The difference in the mean heights of the nasopharyngeal and oral cancer cohorts was statistically significant (p<0.001). Nasopharyngeal cancer patients tend to have a higher palatal vault height compared to those with carcinoma of oral cavity other than hard palate. In such palates with a deep vault, there is increased turbulent air flow leading to increased deposition of air-borne virus/carcinogens. Lingering of these agents may ultimately cause carcinoma of the nasopharynx.