Osteomyelitis of Jaw Bone due to Aspergillosis in Post-COVID-19 Patients: An Observational Study

Background

In the second wave of COVID-19 pandemic, there has been an increase in number of cases with Post-COVID-19 fungal osteomyelitis of jaws. Aspergillosis was found to be one of the causes of osteomyelitis of jaw bones in these patients.

Aim

To evaluate the incidence and pattern of osteomyelitis of jaw due to aspergillosis in post-COVID-19 patients and to discuss the management protocol of the same.

Method

Data were obtained at our institution from the period of January 2021 to June 2021. Patients of all age groups with Post-COVID-19 osteomyelitis of jaw due to aspergillosis and those with combined aspergillosis and mucormycosis infection were included. Patients having rhino-orbito-cerebral fungal infection were excluded.

Results

A total of 47 patients reported to our center. Demographically the average age of the patients was 49.11 years with 72% being males. All 47 patients (N = 100%) had received steroids. 21 of them (N = 44.7%) had diabetes mellitus and 14 (N = 29.8%) patients had other comorbidities. Out of 47 patients, 42 (N = 89.7%) patients were diagnosed with aspergillosis and the remaining 5 (N = 10.3%) cases had a mixed fungal infection of mucormycosis and aspergillosis. On fungal culture Aspergillus flavus was the most common species detected followed by Aspergillus niger and Aspergillus fumigatus. All patients were treated with oral Voriconazole and local surgical debridement. Prompt laboratory testing such as a timely KOH mount, galactomannan test, beta-D-glucan test, histopathology of tissue specimens could help to give an early and definitive diagnosis. The mortality rate we encountered in this study was nil.

Conclusions

Early and definitive diagnosis and immediate initiation of antifungal drug therapy and surgical intervention will significantly reduce the rate of morbidity and mortality.

Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis

Introduction

The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design.

Aim

To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study.

Methodology

The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI.

Conclusion

The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.

Zygomaticomaxillary Osteomyelitis due to COVID-19 Associated Mucormycosis (CAM): A Case Series of 10 Patients

Aim

To highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies.

Methods

A standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS).

Results

Ten out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%.

Conclusions

The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.

Anti-fungal therapy: An overview for maxillofacial surgeons in post-covid-19 fungal infections

India is well known as the diabetes "capital" of the world but now it is also becoming the mucormycosis "capital" of the world. Indian Council of Medical Research has formed an "Evidence-Based Advisory in The Time of COVID-19 on Screening, Diagnosis, and Management of Mucormycosis." As per this advisory, an oral and maxillofacial surgeon forms an integral part of the team dedicated to fight this epidemic of mucormycosis. Also, there are other fungal infections such as aspergillosis which are getting reported in these patients affecting the paranasal sinuses and the jaws. Aggressive surgical debridement and a thorough knowledge of anti-fungal therapy are must in treating these fungal infections. The aim of this article is to give an overview on the available anti-fungal therapy required to manage the ever-increasing rise in fungal infections faced by maxillofacial surgeons in post-COVID-19 patients.

Utility of Vaccum Pressed Silicon Sheet as a Bite Raising Appliance in the Management of TMJ Dysfunction Syndrome

INTRODUCTION

Temporomandibular disorders (TMDs) represent a group of painful conditions involving the muscles of mastication and the temporomandibular joint (TMJ) that frequently encountered in general clinical practice. This study is designed to assess the utility of vacuum pressed silicon sheet as a bite raising appliance in the management of TMJ dysfunction syndrome.

METHODOLOGY

The patients for this study were selected from those with the chief complaint of TMJ disorder. Out of 200 patients, 104 patients were diagnosed with subluxation and 96 patients were diagnosed with internal derangement of temporomandibular joint. All the reported cases were managed conservatively with physiotherapy and muscle relaxant therapy for one week period and followed with silicon bite raising appliance over both the arches in the subsequent period.

RESULTS

All the patients had pain relief within six months duration as graded over verbal analog scale. ANOVA scale was used for comparision of VAS scores.

CONCLUSION

The use of vacuum pressed bite raising appliance in the management of TMJ disorder was found to be satisfactorily effective in alleviation of pain symptom in our study group.

Rehabilitation of Unilateral Congenital Microtia by Implant-retained Prosthesis

Microtia is a major congenital anomaly of the external ear. It includes a spectrum of deformities from a grossly normal but small ear to the absence of the entire external ear. These deformities account for three in every 10,000 births, with bilaterally missing ears seen in fewer than 10% of all cases. Extraoral implant-retained ear prosthesis has been proven to be a predictable treatment option for rehabilitation of such congenital anomalies. This paper aims to present principles of maxillofacial implants, review of literature, advantages, disadvantages, and considerations in treatment planning and treatment phases of an implant-supported auricular prosthesis and prospective developments for ear prosthesis are also discussed. Implant supported ear reconstruction provides excellent support, good retention, and esthetically acceptable appearance to the patient.

Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study

INTRODUCTION

Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume.

MATERIAL AND METHODS

Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases.

CONCLUSION

The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.