Title: Oral and prosthodontic management of a patient treated with advanced orbital and sinonasal mucormycosis
Abstract:
Introduction: Mucormycosis is a rare, aggressive opportunistic fungal infection predominantly affecting immunocompromised individuals, with a reported global incidence of 0.005–1.7 per million and high associated morbidity. Orbital and paranasal sinus involvement frequently necessitates radical surgical resection, resulting in complex maxillofacial defects with significant functional and aesthetic consequences, including impaired speech, mastication, swallowing, facial symmetry, and considerable psychological impact. Obturator prostheses play a key role in managing such defects, sealing oro-nasal communications and restoring speech, swallowing function, and facial support.
Case Report: We present the case of an 18-year-old male who developed orbital and sinonasal mucormycosis, necessitating left orbital exenteration and extended maxillectomy, resulting in a large maxillary defect (Brown's IVb, Aramany Class I). Rehabilitation was complicated by poor general health (type 2 diabetes, electrolyte imbalance, dysphagia), a right-sided neurological deficit causing reduced dexterity, and nasal regurgitation. A sequential, staged prosthodontic approach was undertaken: an initial surgical obturator with a clear base plate and silicone putty, followed by an interim acrylic obturator, and finally a definitive cobalt-chromium obturator incorporating a digitally designed, laser-sintered metal framework with features to enhance retention. Regular modification and relining were required to accommodate rapid changes in the defect during the early post-surgical healing phase, using a hybrid digital-analogue workflow combining functional impressions, intraoral scanning, and framework design, together with chairside adjustment to optimise fit, occlusion, and retention. Oral hygiene instruction was tailored to the patient's reduced dexterity, incorporating carer involvement and video aids, with ongoing multidisciplinary team (MDT) review guiding rehabilitation.
Results: The definitive obturator was successfully delivered, achieving effective sealing of the defect with improved speech, mastication, and aesthetic outcomes. Retention was adequate, though remained slightly limited by anatomical constraints (short crowns, inferior turbinate’s). The patient reported high satisfaction with both functional and aesthetic results.
Conclusion: This case illustrates the value of a staged, adaptive prosthodontic rehabilitation approach for complex maxillary defects following mucormycosis, underpinned by close multidisciplinary collaboration to manage evolving anatomy and systemic factors. Iterative obturator design supported meaningful functional and aesthetic gains, although retention remained constrained by anatomy. The case highlights the limitations of purely digital workflows in achieving accurate occlusion and fit, and identifies opportunities for further optimisation through surgical modification, including resection of the inferior turbinates and consideration of zygomatic implants.
