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| LETTER TO EDITOR |
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| Year : 2019 | Volume
: 18
| Issue : 4 | Page : 211-213 |
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Maxillary mucormycosis causing oroantral fistula in a young female
Sonal Saran, Yash Sharma, Tanvi Khanna, Abhay Pratap Singh
Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| Date of Web Publication | 05-Dec-2019 |
Correspondence Address:
Dr. Sonal Saran
Flat No. 1, Raman and Bhawan, R-enclave, Subhartipuram, Subharti Medical College, Meerut - 250 005, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aam.aam_1_19
How to cite this article:
Saran S, Sharma Y, Khanna T, Singh AP. Maxillary mucormycosis causing oroantral fistula in a young female. Ann Afr Med 2019;18:211-3 |
Sir,
A 24-year-old female patient from rural background presented with complaints of pain over the left cheek, impaired sensation of taste, halitosis, change in voice, feeling of air gushing into a socket while breathing, and fluid going into the nose from the mouth while drinking. The complaint of pain was present over the past 2 years with intermittent exacerbations, whereas the remaining symptoms were present for the past 2 months, for which she took over-the-counter medications without any relief. A complete extra- and intra-oral examination of the patient with appropriate lighting showed poor oral hygiene and a dark opening in the left upper gingivobuccal sulcus likely connecting with the maxillary sinus [Figure 1]. To confirm the diagnosis of oroantral fistula, a high-resolution computed tomography scan of the paranasal sinuses was performed, which revealed a 1.1 cm × 1.93 cm-sized bony defect in the floor of the left maxillary sinus communicating with the oral cavity. Associated mucosal thickening in the sinus cavity was also visualized [Figure 2]. Routine blood investigations were advised to rule out any predisposing conditions, which were found within normal limits. | Figure 1: On examination, the patient had poor oral hygiene. With appropriate lighting, a dark opening was visualized in the left upper gingivobuccal sulcus likely connecting with the left maxillary sinus
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 | Figure 2: (a and b) Noncontrast computed tomography of the paranasal sinuses shows a bony defect in the floor of the left maxillary sinus communicating with the oral cavity. Associated mucosal thickening in the sinus cavity is also visualized
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The patient was admitted and posted for surgical repair with preoperative collection of the sample from mucosal lining. On microbiological evaluation, broad aseptate hyphae with acute-angle branching pattern were seen on potassium hydroxide mount [Figure 3]. On culture, Mucor species grew after 2 days of incubation at 25°C and 37°C. Oral antifungal therapy was started after surgical repair. Postoperative healing was uneventful with complete remission of infection. The patient was discharged after 1 week with advice for 3- and 6-month follow-up. | Figure 3: Potassium hydroxide mount of the sample collected from mucosal lining shows broad aseptate hyphae with acute-angle branching pattern
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Mucormycosis or zygomycosis is a rare fungal infection caused by a saprophytic fungal species. This infection is generally not seen in healthy individuals with intact immune system. Conditions which predispose to mucormycosis include diabetes, preexisting malignancies, human immunodeficiency virus infection, intravenous drug abuse, renal failure, malnutrition, and hematological malignancies. It can lead to life-threatening infection in predisposed individuals. It is very rare in young healthy individuals.[1],[2]
Mucormycosis is typically responsible for acute, aggressive angioinvasive infection in immunocompromised individuals followed by tissue necrosis and infarction. Clinical presentation is quite variable depending on the site of entry. Rhinocerebral form is the most common form of presentation caused by the involvement of nose, paranasal sinuses, orbits, and brain. Cutaneous, pulmonary, gastrointestinal, and disseminated are other forms of infection.[3]
Radiological evaluation includes plain radiography and computed tomography. Plain radiography suffers from the limitation of superimposition of adjacent structures obscuring the fistula. Multidetector computed tomography provides rapid scanning with high resolution and allows reconstruction in various orthogonal planes. Coronal and sagittal reformatting are invaluable for measuring the size of the fistula which helps in planning surgery. Addition of contrast can reveal abnormal enhancement of the sinus mucosa.[4]
Our case presented unusually as localized low-grade fungal infection in an immunocompetent young female. Compromised local host defense by the preexisting chronic sinusitis might be the predisposing factor in our patient. Mucormycosis carries a high mortality rate despite advances in diagnosis and treatment. Control of the underlying risk factors, antifungal therapy, and surgical intervention are required for the treatment of this type of condition.[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: A review of 929 reported cases. Clin Infect Dis 2005;41:634-53.  |
| 2. | Paultauf A. Mycosis mucorina. Arch Pathol Anat 1885;102:543-5. |
| 3. | Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;33:349-65. |
| 4. | Abrahams JJ, Berger SB. Oral-maxillary sinus fistula (oroantral fistula): Clinical features and findings on multiplanar CT. AJR Am J Roentgenol 1995;165:1273-6. |
| 5. | Borgonovo AE, Berardinelli FV, Favale M, Maiorana C. Surgical options in oroantral fistula treatment. Open Dent J 2012;6:94-8. |
[Figure 1], [Figure 2], [Figure 3]
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