Author(s)
Candice B. Yip, MD
Eric T. Carniol, MD MBA
Tapan Patel, MD
Brian Benson, MD FACS
Senja Tomovic, MD
Affiliation(s)
Rutgers NJMS
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to demonstrate understanding of the disease and its need for aggressive treatment. Objectives: Mucormycosis is a rare opportunistic infection caused by Mucorales fungi, mainly affecting immunocompromised patients with poorly controlled diabetes or hematological malignancies. Rhinocerebral mucormycosis is the most common form, whereas mandibular mucormycosis is rare with only a few cases previously reported in the oral surgery literature. We report a case of mucormycosis of the mandible and adjacent soft tissue. Study Design: Case report. Methods: Retrospective review of clinical case. Results: A 70 year old female with a history of breast cancer, chemotherapy, myelodysplastic syndrome, bone marrow transplant, and graft versus host disease presented with fever and acute left side jaw swelling and pain. CT demonstrated an abscess surrounding the left hemimandible and sublingual space, with a foci of air within the left hemimandible. The patient underwent submental incision and drainage without gross purulence. Three days later, the left mental and submental skin became acutely necrotic, and pathology and cultures demonstrated invasive mucormycosis. The patient underwent wide local excision of the submental soft tissue, near total mandibulectomy, and partial glossectomy. Intravenous and topical antifungal agents, intravenous antibiotics, and filgrastim were given. Multiple debridements were done including subtotal glossectomy and floor of mouth resection. Despite aggressive surgical and medical management, the disease continued to progress and two weeks later, the patient was given comfort care and expired. Conclusions: Although most commonly associated with sinonasal disease, mucormycosis can present in other regions of the head and neck including the mandible. Prompt diagnosis, aggressive surgical and medical treatments are important in managing these patients. However, this disease portends poor outcomes, as demonstrated in our patient.