Pandey Akhilesh Kumar, Kaur Amanjot, Gaur Shubham, Kohli Aakash, Goyal Amit, Soni Kapil, Sharma Vidhu, Jain Vidhi, Yadav Taruna, Kumar Deepak, Elhence Poonam, Misra Sanjeev, Anil Abhishek, Chugh Ankita
Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Room no 211, 2A, OPD block, Jodhpur, 342005 Rajasthan India.
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005 India.
Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5585-5595. doi: 10.1007/s12070-024-05037-4. Epub 2024 Sep 11.
To evaluate the quality of life in the post maxillectomy patients due to Coronavirus disease 2019 (COVID-19) associated Mucormycosis (CAM) following rehabilitation with obturators. The study also described the management and treatment outcomes of CAM patients. The study included 80 confirmed patients of CAM. The demographic profile, clinical presentations, predisposing and risk factors, and treatment outcomes were studied. Surgical and medical outcomes were expressed as percentages. After surgical debridement, 27 out of 80 patients were rehabilitated with obturators. The quality of life (QOL) of post debridement at 1 month (T1) vs. post 3 months (T2) of obturator use was measured using the oral health impact profile 14 (OHIP-14) scale. Maxillary sinus was involved in 98.75%, Ethmoid sinus in 51.25% and Sphenoid sinus in 26.25%. Surgical management involved Infrastructure maxillectomy in 56.25%, subtotal maxillectomy in 23.75%, and total maxillectomy with zygoma debridement in 20% of cases. Maxillary sinus debridement was done in 100%, Ethmoid sinus in 51.25%, and Sphenoid sinus in 26.25%. Medical management involved administration of intravenous Amphotericin B (total 3-5 g), and Posaconazole 300 mg OD for 3 months. The measured QOL using mean scores of each domain and the total score of OHIP-14 were lower at T2 (25.5 ± 6.809) compared to T1 (49.55 ± 9.822), (indicating better treatment outcomes) and were found to be statistically significant ( < 0.001). Early diagnosis, controlling risk factors, combined aggressive surgical and medical management reduces the morbidity and mortality of the patients. Early rehabilitation of the maxillectomy defects in CAM patients with temporary obturators mitigates deficient mastication and speech, thereby leading to improved function, aesthetics, and social well-being, and improving the overall QOL of these patients.
评估2019冠状病毒病（COVID-19）相关毛霉菌病（CAM）患者行上颌骨切除术后使用阻塞器康复后的生活质量。该研究还描述了CAM患者的管理和治疗结果。该研究纳入了80例确诊的CAM患者。研究了人口统计学特征、临床表现、诱发因素和风险因素以及治疗结果。手术和医疗结果以百分比表示。手术清创后，80例患者中有27例使用阻塞器进行康复。使用口腔健康影响程度量表14（OHIP-14）测量清创后1个月（T1）与使用阻塞器3个月后（T2）的生活质量（QOL）。上颌窦受累率为98.75%，筛窦为51.25%，蝶窦为26.25%。手术治疗包括56.25%的基础上颌骨切除术、23.75%的次全上颌骨切除术以及20%的全上颌骨切除伴颧骨清创术。100%的患者进行了上颌窦清创，51.25%的患者进行了筛窦清创，26.25%的患者进行了蝶窦清创。药物治疗包括静脉注射两性霉素B（总量3 - 5g）以及口服泊沙康唑300mg，持续3个月。与T1（49.55±9.822）相比，T2时使用OHIP-14各领域平均分和总分测得的QOL较低（25.5±6.809），（表明治疗效果更好）且具有统计学意义（<0.001）。早期诊断、控制风险因素、积极的手术和药物联合治疗可降低患者的发病率和死亡率。CAM患者上颌骨切除缺损早期使用临时阻塞器进行康复可减轻咀嚼和言语功能缺陷，从而改善功能、美观和社会幸福感，并提高这些患者的整体生活质量。
