Mokhtar Ejaz A, Haidry Naqoosh, Verma Sumit, Akbar Shahrukh
Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Patna, Patna, IND.
Oral and Maxillofacial Radiology, All India Institute of Medical Sciences, Patna, Patna, IND.
Cureus. 2022 Oct 14;14(10):e30301. doi: 10.7759/cureus.30301. eCollection 2022 Oct.
Mucormycosis of the mandible (MOM) is a rare fungal infection, and only 23 cases had been reported during the last 50 years worldwide, from seven different countries. Most of the cases were reported in India (n=8, 34%), followed by the United States (n=5, 22%). It is usually associated with an immunocompromised state and generally occurs after tooth extraction. Radiographically, it presents with the characteristic sign of osteomyelitis. Most of the previous case reports/series on MOM described successful outcomes with the resection of the involved segment. However, our experience in managing these cases was quite different and it was observed that resection is seldom required. It was seen that MOM rarely causes cortical perforation. One of the probable reasons is the thicker cortical bone and well-confined boundary of the mandible. Another reason could be the fulminating nature of the disease that leads it to rapidly spread in less resistant medullary bone before perforating cortical bone. During surgery, a clear line was seen separating necrotic medullary bone from healthy cortical bone. The thicker cortical bone of the mandible was found to be resistant to fungal invasion; however, the medullary bone was rapidly invaded. Therefore, the healthy cortical bone could be saved. The preservation of the cortical parts thus helps in maintaining the continuity of the bone. Surgical curettage of necrotic medullary bone is usually the optimal method to manage MOM affecting the mandibular body or ramus region.
下颌骨毛霉菌病（MOM）是一种罕见的真菌感染，在过去50年里，全球仅报道了来自7个不同国家的23例病例。大多数病例报道于印度（n = 8，34%），其次是美国（n = 5，22%）。它通常与免疫功能低下状态相关，一般发生在拔牙后。影像学上，它表现出骨髓炎的特征性征象。之前关于MOM的大多数病例报告/系列描述了切除受累节段后取得成功的结果。然而，我们处理这些病例的经验却大不相同，并且观察到很少需要进行切除。可以看出，MOM很少导致皮质穿孔。一个可能的原因是下颌骨皮质骨较厚且边界局限。另一个原因可能是该疾病的暴发性本质，导致其在穿透皮质骨之前在抵抗力较低的髓质骨中迅速扩散。在手术过程中，可以看到一条清晰的线将坏死的髓质骨与健康的皮质骨分开。发现下颌骨较厚的皮质骨对真菌侵袭具有抵抗力；然而，髓质骨却迅速受到侵袭。因此，可以保留健康的皮质骨。保留皮质部分有助于维持骨的连续性。对坏死的髓质骨进行手术刮除通常是处理累及下颌体或升支区域的MOM的最佳方法。
