FACIAL SWELLING AND PALATAL

ULCERATION IN A DIABETIC PATIENT

Zuhal Tugsel, DDS, PhD, Bahar Sezer, DDS, PhD, and Taner Akalin, DDS,
PhD,
Izmir, Turkey EGE UNIVERSITY
[ Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004 ; 98 : 630-6]

CONTENTS:

Case report

Differential diagnosis

Discussion

Conclusion

References

CASE REPORT:
Demographic data: 64 yrs. / Male
Chief complaint: left sided facial swelling ,
numbness in the infra orbital area, and pain in
the maxillary left molar region
On oral examination:
Suspicious Palatal Ulcer.

3 cm Ragged ulcer was observed on hard

palate that demonstrated a raised
erythematous border and central 0.5 cm area
of exposed bone

In addition the maxillary left quadrant

exhibited evidence of moderate to severe
periodontitis.

 Medical

history:
Insulin dependent diabetes
Mycotic pneumonia
Fungal Pleuritis.

Radiographic analysis:

Panoramic

and Periapical radiographs

bony destruction consistent with

chronic periodontitis in the maxillary left first
and second molar teeth

Plain

sinus films revealed Vague opacification of

left maxillary sinus . But there is no bony

destruction.

Computerized Tomography:

Diffential diagnosis:

Aspergillosis

Paracoccidiomycosis
Wegners

granulomatosis

Squamous

cell carcinoma

Syphilis
Tuberculosis
Zygomycosis

Microscopic findings:

Diagnosis:

Zygomycosis

Management:

Amphotericin-B iv [ 0.8 mg /kg/day]

Left

maxillectomy and orbital exenteration

Patient

placed on Itraconazole and discharged

Discussion:

Zygomycosis is an acute opportunistic

infection.

Most

common forms are Rizopus, Rizomucor,

Mucor, Absida.
Infection

spores.

usually result from inhalation of

5 clinical forms of Zygomycosis

- rhinocerebral
- Pulmonary
- Cutanious
- GIT
- Central nervous sysem.

Pathogenisis:

Inhalation of spores

-> spores germinate -> form hyphae ->

blood vessel [ invasion ] -> clot formation -> necrosis.

Radiographically rhinocerebral Zygomycosis

associated with thickening of the sinus
mucosa, and destruction of the
bony walls of the paranasal sinuses

Histologically It is characterized by extensive

tissue necrosis and Presence of numerous
large
fungal hyphae,

CONCLUSION

Despite aggressive therapy overall mortality rate is high. New

strategies to prevent and treat mucormycosis is urgently needed

REFERENCES:

Bailey and scotts diagnostic microbiology 12th edition

Brouk biology of microorganisms 9th edition

Pathogenesis of Mucormycosis
Ashraf S. Ibrahim,Brad Spellberg,2,3Thomas J. Walsh,4and Dimitrios P. Kontoyiannis 5
Division of Infectious Diseases, Los Angeles Biomedical Research
Institute at HarborUniversity of California at Lo