PMC5824503_01
Panoramic radiograph showing diffuse rarefaction of the alveolar process and the hard palate
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F1
Clinical examination of the affected area revealed gray-colored exposed bone in the maxillary anterior area, and a panoramic radiograph taken before extraction showed diffused rarefaction of the alveolar process and the hard palate [Figure 1].
Coronal computed tomography image showing thickening of mucosa and opacification maxillary antrum with anterior wall destruction
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F2
An magnetic resonance imaging scan showed a radio-opaque maxillary antrum and anterior wall destruction [Figure 2].
Surgically excised maxilla
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F3
Based on these features, a provisional diagnosis of maxillary osteomyelitis was made followed by excision of anterior maxilla [Figure 3].
Whole slide scan showing (arrowheads) vasculitis consistent with inflammatory response to mucor angioinvasion (H&E, original magnification x4)
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F4
H and E stained section revealed pseudostratified ciliated columnar epithelium with edema in the submucosal areas with dense inflammatory infiltrate chiefly composed of eosinophil's interspersed with multiple colonies of thick nonseptate fungal hyphae, branching at right angles to obtuse angles, which were surrounded by extensive necrotic debris based on histopathological features diagnosed as mucormycosis [Figures 4-6].
H&E stained section showing dense inflammatory infiltrate chiefly composed of eosinophils and hyphae branching in right angle and obtuse angles, mucormycotic hyphae, surrounded by extensive necrotic debris. These morphological features define mucor (H&E, original magnification x100)
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F5
H and E stained section revealed pseudostratified ciliated columnar epithelium with edema in the submucosal areas with dense inflammatory infiltrate chiefly composed of eosinophil's interspersed with multiple colonies of thick nonseptate fungal hyphae, branching at right angles to obtuse angles, which were surrounded by extensive necrotic debris based on histopathological features diagnosed as mucormycosis [Figures 4-6].
H&E section reveals numerous fungal hyphae which are aseptate, broad with obtuse angle branching, in right angle, typical of mucormycosis
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F6
H and E stained section revealed pseudostratified ciliated columnar epithelium with edema in the submucosal areas with dense inflammatory infiltrate chiefly composed of eosinophil's interspersed with multiple colonies of thick nonseptate fungal hyphae, branching at right angles to obtuse angles, which were surrounded by extensive necrotic debris based on histopathological features diagnosed as mucormycosis [Figures 4-6].
Postoperative wound healed uneventfully after surgical reconstruction
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F7
This was followed by complete excision of the maxilla, as necrosis extends up to zygomatic bone, and surgical reconstruction of the maxilla was done [Figure 7].