Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-23T23:52:01.260Z Has data issue: false hasContentIssue false

Hard palate perforation due to mucormycosis: report of four cases

Published online by Cambridge University Press:  26 February 2007

H A Barrak*
Affiliation:
Department of Surgery, Medical College of Basra, Iraq
*
Address for correspondence: Dr H A Barrak, PO Box 541, Basra, Iraq. E-mail: [email protected]

Abstract

Introduction:

Mucormycosis is an opportunistic, fulminating fungal infection of the sino-nasal region. It tends to affect people with immune suppression. The hard palate is a rare site of the disease and few cases have been reported in the literature. This report discusses the nature of hard palate mucormycosis, with the aim of outlining possible explanations and reviewing associated characteristics.

Method:

This was a prospective analysis of four cases of hard palate mucormycosis. The patients were referred from the medical department, with uncontrolled diabetes mellitus. An aggressive treatment protocol was used, i.e. an intensive course of antifungal drugs and frequent debridement of dead tissue.

Results:

A painful, dusky red swelling was noticed at the early stages of the hemi-palate lesion. It was eventually followed by deep ulceration and even big perforation. Orbit and intracranial extension was the preceding sign in all instances. The progression of the perforation was not controlled by a full course of treatment. There were two deaths during the treatment course.

In conclusion:

Mucormycosis of the hard palate is an ominous sign. Although rare, the lesion is progressive in nature and barely controlled by treatment. Clinicians should maintain a high degree of clinical suspicion in the management of patients with palatal ulcer and debilitating illness.

Type
Clinical Record
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Fatterpekar, G, Mukherji, S, Arbealez, A, Maheshwari, S, Castillo, M. Fungal disease of paranasal sinuses. Semin Ultrasound CT MR 1999;20;391401CrossRefGoogle ScholarPubMed
2Weir, N. Acute and chronic inflammation of the nose – phycomycoses. In: Mackay, S, Bull, TR, eds. Scott-Brown's Textbook of Otolaryngology, 5th edn.Great Britain: Buttorworth-Heinemann, 1987;236–137Google Scholar
3Kleinman, DM et al. Disease of the eye and the orbit mucormycosis. In: Bruce, Jafek, William, Murrow, eds. ENT Secret. US: Elsevier Mosby, 1996;168, 375Google Scholar
4Macsween, RNM, Whaley, K. Microbial infections. In: Sir Robert, Muir, MacSween, R, Roderick, NM Macsween, Keith, Whaley, eds. Muir's Textbook of Pathology, 13th edn.US: Hodder Arnold, 1992;334Google Scholar
5Alleyne, CH Jr, Vishtch, AG, Spetzler, RF. Long term survival of patient with invasive cranial base rhino cerebral mucormycosis treated with combined endovascular, surgical and medical therapy. Neurosurgery 1999;45:1461–4CrossRefGoogle Scholar
6Lerchenmuller, C, Goner, M, Buchner, T, Berdel, WE. Rhino cerebral zygomycosis in a patient with acute lymphoblastic leukemia. Ann Oncol 2001;12:415–19CrossRefGoogle Scholar
7Pelton, RW, Peterson, EA, Patel, BC. Successful treatment of the rhino-orbital mucormycosis without extent ration, the use of multiple treatment modalities. Ophthal Plast Reconstruct Surg 2001;7;62–6CrossRefGoogle Scholar
8Sykes, LM, Sukha, A. Potential risk serious oral infections in the diabetic patients. J Prosthet Dent 2001;86:569–73CrossRefGoogle Scholar
9Gupta, AK, Mann, SB, Khosla, VK, Sastry, KV, Hundal, JS. Non-randomized comparison of surgical modalities for para nasal sinuses mycosis with intracranial extension. Mycoses 1999;42:225–30CrossRefGoogle Scholar
10Peterson, KL, Wang, M, Canalis, RF, Abemayor, E. Rhino cerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope 1997;107:855–62CrossRefGoogle ScholarPubMed