Management and Maxillofacial Rehabilitation of COVID 19 associated Mucormycosis

Objectives: To study and present a management protocol formulated to treat coronavirus disease-associated invasive fungal sinusitis (mucormycosis) (CAM) and related defects. Methods: A prospective interventional study was conducted at a tertiary care centre over three months, involving patients with mucormycosis of the paranasal sinuses suffering from or having a history of Coronavirus Disease infection (COVID-19) who underwent debridement surgery. A protocol was formulated incorporating all the departments involved in the management of post-COVID-19 Associated Mucormycosis (CAM) patients. A separate protocol for early prosthetic rehabilitation was also developed. Results: Twenty patients underwent surgical and medical intervention along with prosthetic rehabilitation for CAM. All of the patients were post COVID-19 infected and had developed acute symptoms. The maxillary sinus was affected in all these patients and 25% of the patients had involvement of the orbit along with the maxillary sinus. All patients had been administered steroids during the treatment for COVID-19-associated illness. Infrastructure maxillectomy of the right side was done in 35% of patients, bilateral maxillectomy was done in 30% of patients, and two patients underwent infrastructure maxillectomy and orbital exenteration of the right side. Six patients received a surgical obturator inserted on the second-day post-maxillectomy, 8 patients received an intermediate obturator inserted on the 10th-12th day post-maxillectomy and 6 patients received a silicone obturator inserted on the 14th-18th day after bilateral maxillectomy. Conclusions: Early management, prompt treatment and post-operative comprehensive rehabilitation towards an optimum Quality of Life (QOL) can be achieved for good prognosis in patients affected by CAM. The prosthetic rehabilitation protocol provided prosthesis earlier and faster to the patients that improved their QOL.