Ravi M B, Srinivas Sowmya, Silina Ekaterina, Sengupta Soumee, Tekwani Tanvi, Achar Raghu Ram
Department of Prosthodontics, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India.
Department of Human Pathology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Clin Cosmet Investig Dent. 2022 Jan 6;14:1-10. doi: 10.2147/CCIDE.S346315. eCollection 2022.
Mucormycosis, a rare fungal infection seen in diabetes, is now very frequent owing to the deadly triad of COVID-19 infection, diabetes, and rampant use of corticosteroids. Immediate management revolves around therapeutic drugs like antifungals, antibiotics, and aggressive surgical debridement. The cases described in the article explain prosthetic rehabilitation of maxillectomy defects. The findings focus on prosthetic rehabilitation of patients with acquired maxillectomy defects after mucormycotic necrosis post-COVID-19 infection and the techniques to overcome the complications like lack of supporting tissues and post-surgical microstomia. The maxillectomies were performed on patients who suffered a superinfection of mucormycosis after COVID-19 contraction and uncontrolled blood sugar levels. Case 1 elaborates a technique to overcome the complications like lack of supporting structures and microstomia by fabrication of sectional and hollow obturator prostheses using sectional impression technique and lost salt technique. Case 2 explains the management of an extensive defect with a mobile soft tissue flap and lone standing tooth by using a functional impression technique to gain retention and support from the remaining soft and hard tissues. Both the techniques overcome the clinical complications and give predictable outcomes. Prosthetic rehabilitation of such challenging cases needs modifications depending upon the clinical challenges encountered.
毛霉菌病是一种在糖尿病患者中罕见的真菌感染,由于新冠病毒感染、糖尿病和大量使用皮质类固醇这一致命三联征,如今这种感染变得非常常见。立即治疗围绕抗真菌药、抗生素等治疗药物以及积极的手术清创展开。文章中描述的病例解释了上颌骨切除术后缺损的修复。研究结果聚焦于新冠病毒感染后毛霉菌坏死导致获得性上颌骨切除术后缺损患者的修复以及克服诸如缺乏支持组织和术后小口畸形等并发症的技术。上颌骨切除术是在新冠病毒感染后发生毛霉菌病二重感染且血糖水平失控的患者身上进行的。病例1阐述了一种通过使用分段印模技术和失盐技术制作分段式和中空阻塞器假体来克服诸如缺乏支持结构和小口畸形等并发症的技术。病例2解释了通过使用功能性印模技术从剩余的软硬组织获得固位和支持,利用可移动软组织瓣和孤立牙来处理广泛缺损的方法。这两种技术都克服了临床并发症并给出了可预测的结果。对于此类具有挑战性的病例,修复需要根据所遇到的临床挑战进行调整。