Hard palate perforation due to mucormycosis: report of four cases.
BACKGROUND
Mucormycosis is an opportunistic, fulminating fungal infection of the sino-nasal region. It tends to affect people with immune suppression. The hard palate is a rare site of the disease and few cases have been reported in the literature. This report discusses the nature of hard palate mucormycosis, with the aim of outlining possible explanations and reviewing associated characteristics.


METHODS
This was a prospective analysis of four cases of hard palate mucormycosis. The patients were referred from the medical department, with uncontrolled diabetes mellitus. An aggressive treatment protocol was used, i.e. an intensive course of antifungal drugs and frequent debridement of dead tissue.


RESULTS
A painful, dusky red swelling was noticed at the early stages of the hemi-palate lesion. It was eventually followed by deep ulceration and even big perforation. Orbit and intracranial extension was the preceding sign in all instances. The progression of the perforation was not controlled by a full course of treatment. There were two deaths during the treatment course.


CONCLUSIONS
Mucormycosis of the hard palate is an ominous sign. Although rare, the lesion is progressive in nature and barely controlled by treatment. Clinicians should maintain a high degree of clinical suspicion in the management of patients with palatal ulcer and debilitating illness.
Barrak
H A
HA
Department of Surgery, Medical College of Basra, Iraq. husham_1964@yahoo.co.uk
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D001927:Brain Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D003646:Debridement; D048909:Diabetes Complications / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D009957:Oroantral Fistula / Q000209:etiology* / Q000382:microbiology; D021362:Palate, Hard / Q000293:injuries*; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B