Infeccion De Invasion Micotica En La Maxila A Causa De Extracciones Dentales En Pacientes Con Epoc

Clinical

PRACTICE

Invasive Fungal Infection of the Maxilla Following Dental Extractions in a Patient with Chronic Obstructive Pulmonary Disease
Christopher Fogarty, DMD; Frederick Regennitter, DDS; Christopher F. Viozzi, DDS, MD
Contact Author
Dr. Viozzi Email: viozzi.christopher @mayo.edu

ABSTRACT
We report on a 74-year-old male patient with chronic obstructive pulmonary disease(COPD) who developed an invasive fungal disease of the facial bones after several teeth were extracted. He had recently suffered an exacerbation of COPD, treated with a course of corticosteroid therapy. Mucormycosis is an opportunistic fungal pathogen that has the ability to cause significant morbidity and frequently mortality in the susceptible patient. An overview of this class of pathogens and thehistory, examination findings (clinical and radiographic), pathogenesis and medical–surgical treatment of mucormycosis is presented.
MeSH Key Words: maxillary diseases/complications; mucormycosis/complications; mucormycosis/drug therapy; pulmonary disease, chronic obstructive
© J Can Dent Assoc 2006; 72(2):149–52 This article has been peer reviewed.

D

entists are seeing a growing number ofmedically compromised patients in their practices.1,2 The lifespan of patients is increasing and access to medical care for elderly patients has improved; thus, more patients are surviving long-term with significant medical problems. These patients present with systemic disease involving multiple organ systems. They may be taking many medications and using other medical therapies. Today, thisgroup of patients survives much longer than they would have even 10– 15 years ago. The ability to identify patients whose overall health status may not allow them to tolerate surgical or dental manipulation very well is important to avoid the clinical outcome reported here. Invasive fungal infections (mycoses) are uncommon, but when they occur, they are devastating to patients. These infections areopportunistic — they occur when organisms to which we are frequently exposed gain entry to the body due to a decrease in host defenses or through an invasive portal, such as a dental extraction. Mucormycosis is a saprophytic aerobic fungus commonly found in our environment, for example, in bread moulds or decaying vegetation. This organism is frequently found to colonize the oral mucosa, nasalmucosa, paranasal sinuses and pharyngeal mucosa of asymptomatic patients.3,4 These fungi do not usually cause disease in healthy people with intact immune systems, but patients with a number of conditions can be predisposed to the development of invasive fungal disease. These conditions include diabetes mellitus, renal failure, malignancies, intravenous drug abuse, malnutrition states, as well asimmunosuppression and corticosteroid therapy.5,6
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JCDA • www.cda-adc.ca/jcda • March 2006, Vol. 72, No. 2 •

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Invasive fungal diseases that are not recognized early or are treated inadequately are among the most acutely fatal infections known. Case Report A 74-year-old man was referred to the Mayo Clinic’s division of oral and maxillofacial surgery for evaluation of aprogressive nonhealing wound of the left maxilla. He had recently Figure 1: Photograph of nonhealing Figure 2: Axial computed tomography suffered an exacerbation of his left maxillary postsurgical wound. scan at the level of the hard palate chronic obstructive pulmonary disshowing the generalized lytic process in the maxilla, with fluid in the right maxillary ease (COPD), which was managed sinus and anair–fluid interface in the left. with intravenous corticosteroid therapy. The patient went on to develop pneumonia, which was successfully managed with antibiotic therapy, and he was discharged from the hospital doing well. At the time of his discharge, he was on a tapering regimen of oral steroids. Approximately 1 month after discharge from hospital, he presented to his dentist for evaluation...