Post-COVID Mucor Oral Rehabilitation

Patients have suffered greatly due to post-COVID mucormycosis. Mucormycosis, a fungal infection primarily affecting immunocompromised individuals, thrives in environments with high fungal spore counts, often exacerbated by long-term corticosteroid treatments.

Inhalation of fungal spores initiates infection in the nose and paranasal sinuses, potentially spreading to orbital and intracranial structures via blood vessels. The fungus infiltrates arteries, leading to thrombosis and necrosis of hard and soft tissues.

Patient Evaluation

Patients require a comprehensive history and physical examination to determine their suitability for treatment.
Cone-beam computed tomography (CBCT) is crucial for preoperative assessment:
- (A) Assessing alveolar ridge-to-zygoma body distance for implant sizing estimation.
- (B) Evaluating zygomatic bone quality and quantity.

Types of Prostheses

Fixed Prosthesis : The Quad Zygoma concept utilizes four zygomatic implants to rehabilitate severely atrophic maxillae, with implants strategically placed for balanced jaw support. It typically involves a fixed prosthesis, though overdentures can also be retained.
Removable Prosthesis : Complete dentures are used for fully edentulous patients but may not always meet all functional and psychological needs.

Options Over Time

Jaw Reconstruction Surgery : Involves bone grafting and secondary implant placement.
Tilted Implants : Avoids bone grafting by utilising available bone with proper implant distribution.
Alternative Bone Sources : Utilizes zygoma or pterygoids for implant anchorage.

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Indications

Severe maxillary atrophy, where even a single dental implant is impractical, makes the Quad Zygoma a primary treatment choice. It can also rescue patients with prior grafting or failed implants.

Complications

Sinusitis is common with zygomatic implants, though careful pre-surgical planning and sinus evaluation, along with an extra-sinus surgical approach and immediate loading, can mitigate this risk. Other complications include nerve paresthesia, oronasal fistula, and orbital perforation.

Removable Prosthesis

Obturator: Restores surgical defects in the hard or soft palate post-maxillectomy, aiding in swallowing, speech, and chewing.

Fabrication Stages

Surgical : Temporary prostheses maintain hard palate continuity immediately after surgery.
Interim : Adjusted until healing completes, usually lasting 2-24 months.
Definitive : Long-term prostheses like crowns or removable dentures.

Mucormycosis Rehabilitation with PSI (Patient-Specific Implants)

Prosthetic intervention is essential for hard and soft palate defects from mucormycosis, including maxillary and pharyngeal obturators. Prosthetic solutions improve speech clarity, reduce nasal leakage, and restore dental function.

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Two-Part Prosthesis

For extensive midfacial defects, a two-part prosthesis—oral and antral—restores facial symmetry and function with reliable retention methods.

Cast Partial Prosthesis

Metal framework or cast partial prostheses are preferred for hemi-maxillectomy cases, offering durability and enhanced aesthetics.

CAD-CAM and SLS Technology

Computer-aided design (CAD), selective laser sintering (SLS), and 3D modeling streamline prosthesis fabrication for maxillofacial defects, improving comfort and longevity.

Zygomatic Implants

In bilateral hemi-maxillectomy, zygomatic implants provide stable support for prosthetic rehabilitation, addressing maxillary bone loss effectively.

Mucormycosis Management by Midface Reconstruction

From orbit to alveolar bone, midface reconstruction post-mucormycosis resection uses 3D modeling and patient-specific implants for precise surgical planning and outcome.

Conclusion

Accurate placement of implants and prostheses is vital for successful outcomes in midfacial reconstruction.Intraoperative navigation ensures precise positioning, achieving stable occlusion and optimal aesthetics.

Citations

Quad Zygoma: Technique and Realities

Frequently Asked Questions

Post Covid Mucor Oral Rehabilitation is the process of treating and restoring oral health in patients who have recovered from Covid-19 and developed mucormycosis (also known as black fungus) infection in the mouth.

Covid-19 weakens the immune system, making patients vulnerable to fungal infections like mucormycosis, which can affect the sinuses and spread to the mouth.

Patients with poorly controlled diabetes, those on steroids or immunosuppressants, and those with weakened immune systems are at higher risk.

Treatment involves antifungal medications, surgical removal of infected tissue, and sometimes reconstructive surgery to restore oral function.

Prevention involves managing diabetes, using steroids judiciously, maintaining oral hygiene, and avoiding environments with excessive mold exposure.

Complications may include tissue damage, spread of infection to other organs, and in severe cases, life-threatening conditions.

The duration of rehabilitation varies based on the severity of infection and individual recovery, ranging from weeks to months.