Treatment of Extensive Maxilla, Zygoma and Orbital Wall Osteonecrosis Caused by Rhino-Orbital Mucormycosis-A Case Report

白黴菌病是由一種存在於日常環境中的接合菌所引起，會造成多種不同部位的人體感染，尤其是免疫低下的患者。接合菌常藉由侵入血管系統，造成血栓堵塞血管、影響血液供應，進而使周圍組織壞死。在口腔白黴菌病的息者中，較少見急性的上顎骨壞死與大範圍的顏面骨壞死。一般來說，感染白黴菌病的息者預後普遍不佳。而在鼻竇感染的息者，有高達46%的致死率。治療白黴菌病，需要積極的手術介入與抗黴菌藥的合併使用。本文報告一患有糖尿病的六十歲男性，感染鼻眼窩白黴菌病，並引起大範圍之顏面骨壞死。除了抗黴菌療程外，另接受數次手術來移除位於顎部、鼻竇、顴骨、眼眶底與側壁的壞死組織。並於感染控制後，搭配事先利用三維立體模型所塑型之欽合金金屬網，以及顯肌皮辦進行重建。追蹤至今並無復發。

關鍵字

白黴菌病；骨壞死；三維模型；顳肌翻瓣

並列摘要

Mucormycosis is caused by zygomycetes. This fungus can cause a variety of infections in human beings, particularly in the immunocompromised patients. Zygomycetes impinge into the vascular network, resulting in thrombosis and necrosis of the surrounding tissues. Acute necrosis of maxilla is not frequently seen, and extensive facial bone involvement is rare in patients with oral mucormycosis. Sinus mucormycosis is often accompanied by a poor prognosis and a high mortality rate (46%). Therefore aggressive surgical intervention with antifungal therapy is usually necessary. In this report, we presented a case of rhino-orbital mucormycosis in a 60-year-old man with diabetes mellitus. Besides antifungal treatment, this patient also received several surgeries to remove all necrotic tissues, including the palate, maxilla, zygoma and orbital floor and lateral wall. Pre-bent titanium mesh on a 3D prototyping model and a temporalis muscle flap were used to do reconstruction and the results have been uneventful so far.

並列關鍵字

mucormycosis ； osteonecrosis ； 3D prototyping model ； temporalis muscle flap

國際替代計量

Treatment of Extensive Maxilla, Zygoma and Orbital Wall Osteonecrosis Caused by Rhino-Orbital Mucormycosis-A Case Report

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