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新冠后鼻眶脑型毛霉菌病颌面缺损功能修复的模拟与数字协议:病例系列

Analog and Digital Protocols for Functional Prosthetic Rehabilitation of Post-COVID-19 Rhino-Orbito Cerebral Mucormycosis Maxillofacial Defects: A Case Series.

作者信息

Bhargava Anuj, Soni Smita, Raj Kavita, Gupta Mahak, Deshpande Rohan, Khan Mohd Faisal

机构信息

Department of Dentistry, Gandhi Medical College, Bhopal, Madhya Pradesh, India.

Department of ENT, Gandhi Medical College, Bhopal, Madhya Pradesh, India.

出版信息

J Pharm Bioallied Sci. 2023 Jul;15(Suppl 2):S1347-S1350. doi: 10.4103/jpbs.jpbs_79_23. Epub 2023 Jul 11.

Abstract

The current study aims to present our clinical observations and experience gathered during the diagnosis, clinical presentation, medical/surgical treatment, and functional prosthetic rehabilitation of cases of rhino-orbital/cerebral Mucormycosis patients. Mucormycosis is an aggressive, life-threatening invasive fungal infection that occurs in people who are immune-compromised. The rise of ROCM during the second wave of the COVID-19 pandemic in India suggests a more effective association between Mucormycosis and the SARS-CoV-2 delta variant. The treatment strategy for Mucormycosis is an early diagnosis which is critical for a successful outcome. The initial step is to reduce or remove underlying risk factors followed by surgical excision and debridement of the afflicted tissues supplemented with antifungal medication. The first-line antifungal treatment is Liposomal Amphotericin B. Postsurgical resection defects are rehabilitated by either removable partial prosthesis (obturators) or by fixed zygomatic implant/patient-specific implant supported prosthesis. Management of ROCM requires a multidisciplinary approach. This case series highlights detailed medical, surgical, and functional prosthetic management modalities adopted by our team in managing such a dreaded disease which may be used as a tool for the formulation of standardized prevention and management/treatment/rehabilitation protocols in the future so that disease morbidity and mortality be reduced and an endemic outbreak could be averted.

摘要

本研究旨在介绍我们在鼻眶/脑毛霉菌病患者的诊断、临床表现、内科/外科治疗及功能性修复康复过程中所积累的临床观察和经验。毛霉菌病是一种侵袭性、危及生命的真菌感染,发生于免疫功能低下的人群。在印度第二波新冠疫情期间鼻眶脑型毛霉菌病(ROCM)的增加表明毛霉菌病与新冠病毒Delta变异株之间存在更有效的关联。毛霉菌病的治疗策略是早期诊断,这对成功治疗至关重要。第一步是减少或消除潜在风险因素,随后对患病组织进行手术切除和清创,并辅以抗真菌药物治疗。一线抗真菌治疗药物是脂质体两性霉素B。术后切除缺损通过可摘局部义齿(阻塞器)或固定的颧骨种植体/定制种植体支持的义齿进行修复。ROCM的管理需要多学科方法。本病例系列突出了我们团队在管理这种可怕疾病时所采用的详细的内科、外科和功能性修复管理模式,这些模式未来可作为制定标准化预防和管理/治疗/康复方案的工具,从而降低疾病的发病率和死亡率,并避免地方性暴发。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d4a/10485534/1675e49f86c4/JPBS-15-1347-g001.jpg

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