A Non-healing Ulcer with Unilateral Facial Palsy

Abstract

Introduction: Oral cavity is a hub for millions of microorganisms which are non pathogenic, but in immunocompromised states, plethora of diseases emerge which may be the most rarest and fatal. Mucormycosis has emerged as one such disease due to rise in the incidence of immunosuppressive conditions such as uncontrolled diabetes. It manifests as rhinocerebral, gastrointestinal, pulmonary and cutaneous forms. Presentation of Case: A 53 year old female patient reported with a chief complaint of noticing a painless large ulcer in the palate. There was also history of swelling associated with continuous burning sensation only on the right middle third of face with difficulty in closing right eye, raising right eyebrow, speaking and inabilty to smile. Bell’s sign was positive. She also had recurrent episodes of fever and vomiting. Imaging with CT and MRI showed no bony destruction but a wide spread soft tissue lesion from palate upto the cavernous sinus. Culture and histopathology confirmed mucormycosis. Discussion: Mucormycosis is the third most common opportunistic fungal infection caused by a saprophytic fungus Mucor. This invasive infection can spread rapidly to intracranium causing various morbidities. Facial nerve palsy is one such rare complication reported in the present case. Explicit investigations including imaging, serology, histopathology and culture are crucial for appropriate diagnosis. Treatment includes parenteral and oral antifungals.  Conclusion: Mucormycosis is a rare encounter in dental practice especially with initial presenting intraoral symptom. The present paper presents one such rare extensive case of Mucormycosis in a compromised patient with extensive investigations and management.