Palatal Involvement Research Articles

Need for orthognathic surgery in cleft patients from Northern Finland.

Northern Finland has a unique distribution of clefts compared to the rest of Europe and Finland. This may reflect the need for orthognathic surgery among Northern Finland's patient pool. The aim of this study was to compare previously operated patients aged 18 years or older with cleft lip, cleft lip and alveolus, cleft lip and palate, cleft palate and to evaluate the need for orthognathic surgery in order to achieve a stable and functional occlusion. Materials and methods: The study group consisted of all 18-years-old cleft patients treated in the Oulu Cleft Center. The total amount of patients was 110. The patients were compared retrospectively using patients' hospital records. The majority of patients did not have any cleft-associated syndrome. The need for maxillary or bimaxillary orthognathic or corrective-jaw surgery was evaluated by the Oulu Cleft Team. A descriptive and statistical analysis was used to determine the need for orthognathic surgery according to sex and cleft type. There were nineteen patients of the total of 110 patients who met the criteria requiring corrective-jaw surgery (17,3%). In total 12 males (25,0%) and 7 females (11,3%) were evaluated for the need of orthognathic surgery. Sixteen of the 19 patients had palatal involvement of the cleft. The need for orthognathic surgery was greater in the cleft lip palate and cleft palate patient groups compared to cleft lip alveolus or cleft lip groups. This study also found that males from Northern Finland need surgery more often than females.

Idiopathic Lympho-Plasma Cellular Mucositis; A Diagnostic Predicament.

The term "idiopathic lymphoplasmacellular mucositis" (ILPM) refers to a set of conditions marked by extensive lymphocyte and plasma cell infiltrates in the submucosa which can involve the oral cavity, upper respiratory tract and the genital epithelium. There is no recognized cause of ILPM, and the diagnosis is mostly done on an exclusion basis. Herein, we report a 32-year-old man presented with an erosive ulcerated lesion on the hard palate and review the literature regarding the possible differential diagnosis including squamous cell carcinoma. We also reviewed the previously reported cases of ILPM with palatal involvement to summarise clinical presentation, treatment, and outcome of the entity to date.

Palato-Antral Involvement of a Primary Extracranial Sinonasal Meningioma

Primary extracranial sinonasal meningiomas are one of the rarest tumours involving the head and neck region. Very few reports exist with additional involvement of the palato-antral region. This paper describes a case of primary extracranial sinonasal meningioma with palatal involvement and the management of the same. The patient was taken up for surgical excision via intra-oral and endoscopic approaches. Postoperative healing was uneventful with no recurrence noted over 2 years. A palatal obturator was used for rehabilitation. The diagnosis of this pathology needs additional immunohistochemistry testing for confirmation and treatment entails complete surgical excision which assures no recurrence or delayed presentation of residual disease in follow-up.
 Keywords: primary extra cranial meningioma; sinonasal; maxilla ; palate.

Bilateral nevus of Ota: A case series and literature review

Nevus of Ota is a dermal melanocytic hamartoma clinically characterized by confluence of blue-to-gray macules, distributed along the ophthalmic and the maxillary divisions of the trigeminal nerve. It is usually unilateral and only 5–15% of cases have been reported to have bilateral involvement. This entity has been reported predominantly in darkly pigmented individuals, particularly in Asians and blacks. Case reports and case series describing this unique entity are very rare in literature. Herein, we report three cases of bilateral nevus of Ota at a tertiary care center in Eastern India. A detailed history, clinical examination, Wood’s lamp examination, and histopathological correlation were done in all the cases. In all the cases, lesions started with bluish pigmentation on the sclera and out of three cases, two had palatal involvement as well.

Exponential Rise of Fungal Infection Reported in Rajkot Civil Hospital in Covid Pandemic Era: A Retrospective Study.

Mucormycosis is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes. Mucormycosis is an aggressive, life-threatening infection requiring prompt diagnosis and early treatment. Wide spread use of steroid and higher antibiotics may cause immune irregulation in post covid patients. A hallmark of mucormycosis infection is the presence of extensive angioinvasion with resultant vessel thrombosis and tissue necrosis. We reported exponential rising cases of fungal infection in covid pandemic era. Here we published epidemiological data of 773 fungal infected cases operated in ENT department of PDU Medical college, Rajkot in 2021. We have documented patients demographic data with comorbidity, paranasal sinuses with orbital, palatal and cerebral involvement, evaluation method, surgical and post surgical management protocol which we followed in our institute to treat all cases. We got promising result in terms of survival and less morbidity. Early presentation, less comorbidity, proper evaluation and immediate debridement with systemic antifungal coverage for adequate duration proved to be mainstay treatment of fungal infection in covid pandemic era.

Covid-Associated Mucormycosis in a Case of Wegener's Granulomatosis: A Management Challenge.

A Gentleman in his 40s presented to us with left-sided hemifacial pain and nasal discharge for the last three days. He has been on immunosuppressive therapy for Wegener's Granulomatosis for over five years. Crusting was seen in the Left middle meatus upon clinical examination. Based on the post-covid status, steroid therapy, KOH mount, and radiologic imaging, a provisional diagnosis of Sinonasal mucormycosis was considered. He was posted for emergency debridement followed by Liposomal Amphotericin B and steroid therapy. Surgical histopathological specimens were suggestive of Mucormycosis. Limited sinonasal disease with no intracranial, orbital, or palatal involvement was seen in a background of Wegener's Granulomatosis, Covid, and immunosuppressive therapy. Steroids are condemned as a predisposing factor to mucormycosis. Still, the combination of Liposomal Amphotericin B and steroids was used, opening new avenues for managing mucormycosis in patients with vasculitis. The patient is well nine months post-surgery with no signs of disease relapse.

Understanding Correlation of Polysomnography Parameters with Drug Induced Sleep Endoscopy in Obstructive Sleep Apnea.

The aim of this study was to analyze drug-induced sleep endoscopy (DISE) findings performed in 64 patients and to evaluate the association of DISE findings with PSG parameters. This retrospective, single center, observational study included patients with obstructive sleep apnoea (OSA) who have undergone DISE as part of surgical planning. DISE was performed using dexmedetomidine infusion. The data were documented as per VOTE (velum, oropharynx, tongue base and epiglottis) classification. The patient characteristics and level 2 Polysomnography (PSG) findings were analyzed with DISE findings. Among 62 patients, mean AHI and lowest oxygen saturation levels were 39.68 ± 27.59 and 78.36 ± 9.38, respectively. Mean ESS, SSS and PSQI levels were 10.74 ± - 4.96, 7.73 ± - 1.52, and 8.92 +/- 4.99, respectively. A Single level of obstruction was observed in 4.8% patients, followed by 40.3%, 43.5%, and 11.3% were found to have 2, 3, and 4 levels of obstruction, respectively. All patients had palatal involvement, followed by the oropharyngeal (88.7%), the tongue base (59.7%), and the epiglottis (12.9%) obstruction. There was no significant correlation between partial collapse at velopharynx with AHI. However, complete collapse at the level of the oropharynx (p < 0.05) and the tongue base (p < 0.001) showed a statistically significant association with AHI. Also, a significant correlation was observed between the number of sites and AHI Grade (p < 0.0001). The study helps to understand the association of different patterns and degrees of anatomical obstruction in OSA with different PSG parameters. PSG and DISE findings are complimentary to each other in treatment planning and selection of surgical procedures.

Factors affecting clinical outcome in COVID-associated rhino-orbito-cerebral mucormycosis (CAROM) patients—An ambispective, single-arm, observational study

BackgroundCOVID-associated Rhino-Orbito-Cerebral Mucormycosis (CAROM) appeared as an epidemic in India during the second wave of the COVID-19 pandemic during the months of March to May 2021. Though many reports have highlighted cross sectional and short-term attributes related to CAROM, long term follow up data is sparse. ObjectiveThis report aims to analyze the follow-up outcomes in consecutive patients presenting to us during the epidemic. Patients and methodsThis was an ambispective observational analytical study, recruiting the consecutive patients admitted to our tertiary care centre during the period of the CAROM epidemic. The mortality rate during the follow-up and various factors affecting survival were studied using univariable and multivariable statistics with the Stata 14.0 software. ResultsOf the 189 patients studied, eight were lost to follow-up. The outcome analysis was performed for the 181 patients. 93.6 % (162/173) of the patients had diabetes. The All-cause mortality was 45 % (81/181), while the ROCM-specific mortality was found to be 24 % (46/181) at a median follow-up of 176 days (IQR: 21–217 days). With univariable analysis, increasing age, higher serum IL-6 levels, presence of additional comorbidities (in addition to Diabetes and hypertension), bilateral disease, skin necrosis, palatal involvement, infratemporal fossa involvement, and impaired vision/ocular movements were found to be associated with increased mortality. However, on multivariable analysis, only 1) increasing age, 2) raised serum IL-6 levels, and 3) bilateral disease were predictive of increased mortality. Surgical debridement (endoscopic, palatal removal, orbital exenteration, neurosurgical intervention) was associated with significantly reduced mortality on both univariable and multivariable analysis. ConclusionOur intermediate-term follow-up data showed advanced age at presentation, raised IL-6 levels, and bilateral sinonasal involvement to be predictive of increased mortality, while surgical debridement is significantly protective from mortality in CAROM patients.

Invasive Fungal Rhinosinusitis: Clinical and Surgical Factors Affecting Its Prognosis and Disease-Specific Morality.

The purpose of this study is to discoverfactors that determinemortality in patients with invasive fungal rhinosinusitis. This retrospective study included 17 patients diagnosed with invasive fungal rhinosinusitis and who had undergone treatment in our department, including both surgical and medical management between January 2020 and October 2020. There were four malepatients and 13 female patientswhose mean age was 46 ± 15.67 years, ranging from 20 to 70 years. All the patients were immune-compromised because of diabetes mellitus. We studied the factors affecting the mortality of patients affected with this disease; it included the extent of disease (paranasal sinus, palatal, orbital, or intracranial involvement), serum glucose level (SGL), and C-reactive protein (CRP) levels. Only one patient had paranasal sinusinvolvement alone, but the patient became disease-free after treatment. The disease-specific mortality rate was two (33.3%) of six patients with palatal involvementand four (50%) of eight patients with intracranial involvement where four patients did not have disease control at the time of discharge and did not follow up. The death rate in orbital involvement was 20% (three of 15 patients) and five patients with intra-orbital involvement left the hospital against medical advice. The analysis of data demonstrated that only intracranial (p = 0.01) involvement in addition to the nasal cavity and paranasal sinus involvement had a statistically significant effect on survival rate unlike intra-orbital (p = 0.510) and palatal involvement (p = 0.171). Early endoscopic nasal inspection, diagnosis, and treatment are critical for disease-specific mortality in invasive fungal rhinosinusitis since orbital or cerebral involvement is linked to a poor prognosis. Patients who come with uncontrolled diabetes and ophthalmological and palatal involvement with positive findings on nasal examination should necessitate urgent histopathological and radiological workup.

Does Early Referral Lead to Early Repair? Quality Improvement in Cleft Care.

Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR. Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded. Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027). Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.

Nevus of Ota with palatal involvement: a case report

Nevus of Ota is a macular discoloration of the face which is most commonly found in the Japanese and females are more commonly affected than males. It is first described by Ota and Tanino in 1939, involves the skin along the distribution of first and second division of trigeminal nerve. Involvement of the palatal mucosa occurs rarely in nevus of Ota, it usually blends with the oral mucosa and is typically irregular, undefined and often present as a mottled patch. We describe here the case of nevus of Ota with palatal involvement in a 13-year-old Asiatic boy. His past medical history revealed the presence of the lesion since birth. There were no other pigmented lesion locations. The exact etiology of nevus of Ota is still unknown but they have the potential to undergo melanomatous change.

Post COVID-19 Mucormycosis-The Horizon.

Acute Invasive Fungal Rhinosinusitis is a rare condition which recently has gained attention due to its increased occurrence in the post COVID-19 patients past the second wave. The current study retrospectively evaluates the occurrence of Acute Invasive Fungal Rhinosinusitis (Mucormycosis) in post COVID-19 (Corona Virus Disease-19) patients. A descriptive study included patients diagnosed with Acute Invasive Fungal Rhinosinusitis (Mucormycosis) after recent COVID-19 infection. 110 patients were evaluated retrospectively with histopathological confirmation of Mucormycosis. Surgical treatment was restricted to patients who tested Real Time Polymerase Chain Reaction (RT PCR) negative for COVID-19 except for three patients who were tested positive. Antifungal agents were given to patients following surgery. A total of 110 patients with a mean age of 48.42 years were included. The most common risk factor was diabetes mellitus (88.2%). Sino-nasal, orbital, palatal and intracranial involvement were 57.9%, 48.5%, 12.7% and 5.6% respectively. Histopathological confirmation revealed mucormycosis. The most common reported symptoms were periorbital oedema (20.5%), headache (20.3%), gingival swelling (18.5%) facial pain (18.4%) and facial swelling (18.2%). All the patients were treated with surgical debridement and antifungal medications. The overall survival rate was 95.32%. Acute Invasive Fungal Rhinosinusitis is a life-threatening opportunistic infection. Patients with moderate to severe COVID-19 infection are more susceptible to it. Uncontrolled diabetes mellitus and intake of corticosteroids increase the risk of developing Acute Invasive Fungal Rhinosinusitis. Early diagnosis and timely management can improve survival rates of the patients.

Rhino-orbital mucormycosis with palatal involvement: series of four cases

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;Mucormycosis (Zygomycosis) is a rare, opportunistic fungal infection caused by mucorales.­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­ The clinical hallmark of invasive mucormycosis is angioinvasion and subsequent thrombosis. Palate is the least common site and ulceration with palatal perforation is late occurrence. Involvement of oral cavity usually appears as palatal ulceration or necrosis with denudation of bone and later perforation of palate. In our cases, the patients had both debilitating conditions resulting from poorly controlled diabetes and acute inflammatory immune response due to COVID-19 infection. Radiographically opacification of sinuses may be observed in conjunction with patchy effacement of bony walls of sinuses. Potassium hydroxide smear of lesion can reveal non septate fungal hyphae. Culture on sabouraud’s dextrose agar is preferred but histopathological examination of biopsy specimen is conclusive. Successful treatment of mucormycosis consists of rapid diagnosis of the condition followed by radical surgical debridement of infected necrotic tissue with systemic administration of antifungal drugs. Mucormycosis, along with other deep fungal infections, should be considered as an important outcome of SARS-CoV-2 infection.&lt;/span&gt;&lt;/p&gt;

Oncoplastic Reconstruction of Maxillary Defects with Palatal Involvement in Children and Adolescents: Lessons Learned from Treating 10 Consecutive Patients

Oncoplastic Reconstruction of Maxillary Defects with Palatal Involvement in Children and Adolescents: Lessons Learned from Treating 10 Consecutive Patients

Does Early Referral Lead to Early Repair? Quality Improvement in Cleft Care

BACKGROUND/PURPOSE: Cleft lip and palate (CLP) is the most common congenital birth defect of the head and neck, occurring in approximately 1 in 700 live births. This diagnosis can often be made prenatally by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of age) for unilateral cleft lip, regardless of cleft width, has been the mainstay of cleft lip reconstruction at our institution for the past 6 years. Prior to this novel protocol, traditional lip repair (TLR) was performed at 3-6 months of age ± preoperative nasoalveolar molding (NAM). Previous publications from this institution report on the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred to our institution for prenatal consultations to discuss ECLR. The purpose of this study was to evaluate the timing of both prenatal cleft diagnosis and preoperative surgical consultation as well as referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR. METHODS: A retrospective chart review evaluated patients who underwent ECLR or TLR±NAM from November 2009-January 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral pattern, were abstracted upon review. Inclusion criteria dictated: age <3 months (ECLR group) or 3-6 months (TLR); no major comorbidities (ASA class I/II); and diagnosis of non-syndromic unilateral cleft lip without palatal involvement. Patients >6 months, or with bilateral cleft lip, cleft palate, clefts associated with craniofacial syndromes, or significant systemic comorbidities were excluded. RESULTS: Upon review, 51 patients (47.7%) received ECLR while 56 patients received TLR (52.3%). The average age at surgery was 31.8 days for the ECLR cohort and 112 days for the TLR cohort. Of these 107 patients, 75 patients (70.1%) were diagnosed prenatally with unilateral cleft lip while only 5.6% of families (6/107) had a prenatal consult for cleft lip repair, all of which underwent ECLR (11.8% of ECLR cohort). The majority of patients who received ECLR were referred by a pediatrician (n=39, 76.5%). A statistically significant association was found between the incidence of prenatal consults and ECLR (p=0.008). Additionally, prenatal diagnosis of unilateral cleft lip was significantly correlated with the incidence of ECLR (p=0.027). CONCLUSION: Our data demonstrates significance between prenatal diagnosis of cleft lip and prenatal surgical consultation with the incidence of ECLR; accordingly, we advocate for education to the referring providers as well as those in the surrounding community about the benefits of ECLR and the potential for prenatal surgical consultation. Efforts will be expanded to Obstetrician/ Gynecologists and Maternal-Fetal Medicine providers in the hopes that patients and families alike may enjoy the myriad benefits of ECLR. Further research should investigate the correlation of socioeconomic status with prenatal consultation for ECLR.

Prognostication of Sino-Nasal Mucormycosis.

Introduction:For the purpose of prognostication of sinonasal mucormycosis, a detailed analysis of the clinical, diagnostic, therapeutic and outcome parameters has been contemplated.Materials and Methods:Retrospectively data was collected for all patients of sinonasal mucormycosis managed in a tertiary care hospital in last 5years. Results:Diabetes was the commonest comorbidity among total of 52 cases. Disease extent-wise, 16, 23 and 13 patients had sino-nasal (SN), rhino-orbital (RO) and rhino-orbito-cerebral (ROC) mucormycosis respectively. Median cumulative Amphotericin-B administered was 3.5gms and 94.2% of cases underwent surgical debridement depending on the disease extent. With a median follow-up of 18months, 67% of the patients are alive and disease free, 2% are under treatment and 29% of patients have expired. The mortality rate was 12.5% in SN, 30.5% in RO and 38.5% in ROC mucormycosis. Palatal and orbital involvement is associated with statistically significant mortality risk at one month. Conclusions:Mortality rate in sino-nasal mucormycosis can be significantly curtailed with prompt control of underlying comorbidity, aggressive medical and adequate surgical management.

Bilateral nevus of Ota with palatal involvement, unilateral nevus of Ito, and a port-wine stain: A rare presentation

Nevus of Ota and nevus of Ito are dermal melanocytoses, usually presenting themselves as a bluish-black or grayish-brown, patchy, diffuse, or mottled pigmentation of the skin. They share a common pathogenic mechanism involving failure in the migration of melanocytes from the dermis to the epidermis and differ only in the sites of their distribution on the body. Nevus of Ota, often unilateral, may rarely be bilateral or may involve the oral mucosa. Even rarer is its association with nevus of Ito and other extracutaneous features. A port-wine stain is a form of congenital capillary malformation presenting itself as a pinkish-red to purple discoloration, most commonly of the unilateral head and neck area. Only 25% of cases occur on other sites of the body. The presence of a port-wine stain in conjunction with two different dermal nevi has been an exceedingly rarely reported entity. Herein, we report a 26-year-old male who presented himself with a bilateral nevus of Ota with oral mucosal involvement and associated with nevus of Ito and a port-wine stain.

The spectrum of radiological findings of rhino orbital cerebral mucormycosis with endoscopic and histopathological features in patients with COVID 19: A descriptive study

Background: There had been an increasing incidence of mucormycosis during the COVID-19 pandemic. Aim: This study evaluates the pattern of radiological imaging, endoscopic and histopathological features of rhino-orbital cerebral mucormycosis in patients with COVID-19 infection. Materials and Methods: The study included 31 patients with culture/biopsy-proven mucormycosis and COVID-19 infection from November 1, 2020, to December 31, 2021, in a single tertiary care centre. This study was approved by institutional ethics committee. Computed tomography (CT)/magnetic resonance imaging (MRI) images, endoscopic, and histopathological findings were retrospectively analyzed to look for the extent and pattern of disease. Statistical analysis was performed through descriptive statistics. Results: The imaging spectrum showed paranasal sinus involvement (n = 31; 100%), nasal involvement (n = 14; 45.16%), oral and palatal involvement (n = 6; 19.3%), deep neck/face space involvement (n = 25; 80.6%), orbital involvement (n = 20; 64.5%), vascular complications (n = 9; 29%), skull base involvement (n = 12; 38.7%), and cerebral involvement (n = 10; 32.2%). Endoscopy showed black necrotic tissue and slough mostly affecting middle turbinate, maxillary, and sphenoid sinuses. CT showed 100% sensitivity and specificity for the detection of sinonasal osseous erosion. Histopathology examination revealed mucormycosis as broad aseptate, predominantly 90° branching hyphae with macrophage and neutrophilic infiltration in 93.5%, granuloma in 61.3%, cavity formation in 48.4%, and angioinvasion in 77.4%. Diabetes mellitus was the predominant coexisting morbidity for mucormycosis. The mean time interval between COVID-19 diagnosis and mucormycosis was 18 days. Conclusion: CT revealed hyperdense contents within sinuses with osseous erosion; while MRI showed T2 hypointense, heterogeneously enhancing lesions with adjacent structural infiltration, orbital inflammation, cavernous sinus and internal carotid artery thrombosis, and intracranial complications such as infarct, hemorrhage, meningitis, and abscess. Neutrophilic infiltration and angioinvasion were predominant histopathological characteristics while necrosis with eschar formation was demonstrated through endoscopy.

Risk factors for palatal and orbital involvement in mucormycosis epidemic–Report of a center in India

BackgroundMucormycosis of the nose and paranasal sinuses has emerged as an epidemic following COVID-19 pandemic. The management involves surgical debridement, the extent of which depends on the bulk of the disease. Extension to the orbit and palate depends on the involvement of specific sites in the nose and paranasal sinuses. This study intended to identify those sites. Materials and methodsThis was a single-center case-control study. There were 3 groups according to the region involved (Palate, orbit and both). The fourth group with neither involvement was the control. Scoring system was used to estimate the bulk of disease according to the site involved in MRI scan. Odds ratio and chi-square tests were used to study risk and association respectively. ROC curve was obtained for the MRI scores of the cases and controls. Results214 patients were studied in all; 44.39% and 61.68% had palate and orbit involvement, respectively. Maxillary sinus roof had significant association and the highest risk for spread of disease into the palate. The risk for the orbit to be involved was increased when there was disease in the cavernous and sphenoid sinus. For the orbit, the site with the significant association was the ethmoid sinus, infratemporal fossa and roof of the maxillary sinus. ConclusionDue attention should be given for clearance during surgical debridement to the high-risk sites to prevent recurrences and reduce morbidity and mortality. MRI scores were most helpful to identify the bulk of disease when both palate and orbit were involved.

Actinomycotic Osteomyelitis of Maxilla in a Diabetic Patient- “A Rare Case Report &amp; Review of Literature”

Actinomycosis may be a relatively rare infection caused by saprophytic bacteria of the mouth and alimentary canal which will become pathogenic. The chronic hyperglycemia in Diabetes Mellitus induces events that promote structural changes in various tissues and are related to problems in wound healing. This infection remains largely unknown to most clinicians due to its different presentations, and palatal involvement is extremely rare. This report describes the case of a 50-year-old man who was diagnosed with actinomycosis involving mucosal surface. The main clinical, histopathologic, and therapeutic characteristics and diagnosis of actinomycosis are reviewed. Till date, 4 cases of actinomycosis involving the palatal surface are reported.