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COVID-19后上颌骨毛霉菌病性骨髓炎手术缺损的物理治疗管理

Physiotherapy Management for Surgical Defect of Operated Mucormycotic Osteomyelitis of Maxilla: Post COVID-19.

作者信息

Kaple Gayatri S, Patil Shubhangi, Mundada Purva H, Kaple Nikita A

机构信息

Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Wardha, IND.

出版信息

Cureus. 2023 Feb 7;15(2):e34733. doi: 10.7759/cureus.34733. eCollection 2023 Feb.

Abstract

The maxilla is among the jaw bones with a lot of blood flow. Maxillary bone necrosis is uncommon and can be caused by infection, trauma, or unusual metabolic abnormalities. The maxilla is a vital bone that forms the roof of the mouth cavity.  is a prevalent fungus that infects the maxilla, particularly in diabetic and immune-compromised people and post-COVID-19 patients.  is an inflammatory condition affecting the bone and marrow tissues. It is an opportunistic infection that occurs due to the host's susceptibility to illness due to the complication of other diseases. The patient, in this case, has the chief complaint of a defect in the palate. Based on a CT brain, buccal X-Ray, and HRCT scan of Thorax. The patient's condition was diagnosed as a surgical defect in a post-operated case of mucormycotic osteomyelitis of maxilla post-COVID-19 infection. The right lower lobe's posterior segment noted a tiny soft tissue density nodule. The operated case of a surgical defect of mucormycotic osteomyelitis of maxilla post-COVID-19 infection was treated with a surgical intervention that is surgical curettage and debridement of the left maxillary sinus, bilateral fibrotomy, and reconstruction with bilateral nasolabial flap under general anesthesia. However, our objective is to enhance the quality of life, increase ventilation, increase the shoulder joint's range of motion, and enhance the joint play of the temporomandibular joint so that the patient can go back to his usual activities without difficulty. A complete pulmonary rehabilitation plan was designed to meet the patient's objectives, executed, and followed for one month. It comprised myriad interventions like bedside sitting, facial expression exercises, mouth opening exercises, neck exercises, dynamic quadriceps and hamstring, active range of motion exercises for shoulder joints, thoracic expansion exercises, and breathing exercises like diaphragmatic breathing.

摘要

上颌骨是颌骨中血流丰富的骨骼之一。上颌骨坏死并不常见,可由感染、创伤或异常的代谢异常引起。上颌骨是构成口腔顶部的重要骨骼。 是一种常见的真菌,可感染上颌骨,尤其是糖尿病患者、免疫功能低下者和新冠肺炎康复患者。 是一种影响骨骼和骨髓组织的炎症性疾病。它是一种机会性感染,由于宿主因其他疾病的并发症而对疾病易感所致。在这种情况下,患者的主要诉求是腭部缺损。基于脑部CT、颊部X光和胸部高分辨率CT扫描。患者的病情被诊断为新冠肺炎感染后上颌骨毛霉菌病性骨髓炎术后的手术缺损。右下叶后段发现一个微小的软组织密度结节。对新冠肺炎感染后上颌骨毛霉菌病性骨髓炎手术缺损的病例,在全身麻醉下进行了手术干预,即对上颌窦进行手术刮除和清创、双侧纤维切开术,并采用双侧鼻唇瓣进行重建。然而,我们的目标是提高生活质量、增加通气、增加肩关节活动范围以及增强颞下颌关节的关节活动,以便患者能够毫无困难地恢复日常活动。制定了一个完整的肺康复计划以实现患者的目标,该计划已执行并持续了一个月。它包括无数干预措施,如床边坐立、面部表情练习、张口练习、颈部练习、动态股四头肌和腘绳肌练习、肩关节主动活动范围练习、胸廓扩张练习以及诸如腹式呼吸等呼吸练习。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1616/9997684/446766864daf/cureus-0015-00000034733-i01.jpg

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