Management of Recurrent Rhinomaxillary Mucormycosis and Nasal Myiasis in an Uncontrolled Diabetic Patient: A Systematic Approach

Abstract

Mucormycosis is a rare but often fatal fungal infection caused by a group of fungus known as the Mucorales. This fungus can cause varieties of infections in human beings, especially in an immunocompromised condition. According to various studies, the mortality rate ranges from 10% to 100% depending on the location and site of infection accompanied by underlying diseases. Rhinomaxillary involvement is the most common form of mucormycosis predominantly occurring in patients with uncontrolled diabetes. Necrosis of the maxilla in patients with rhinomaxillary form is less evident as the maxilla is richly vascular, but in case of immunocompromised status, it becomes a common clinical finding. Due to the necrosis of the maxilla, maggots have been found in the nasal and oral cavity which adds to the deteriorating clinical condition. This case report describes a combined medical, surgical, psychological, and prosthetic approach in effectively managing one such case of rhinomaxillary mucormycosis.

Keywords: Amphotericin B; immunocompromised; interim obturator; mucormycosis; myiasis.

Figure 1

Intraoral photograph showing black discoloration of the palate and necrosis of the maxilla

Figure 2

Computed tomography paranasal sinus showing erosion of the maxillary alveolar ridge, ethmoidal trabeculae, left sphenoidal wall, and no cranial or orbital involvement

Figure 3

Intraoral view of the patient with obturator in place