PMC4856500_01
Extra oral image showing sunken appearance of face and loss of naso labial fold on left side
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Extra oral examination revealed a gross facial asymmetry with sunken appearance with loss of normal nasolabial fold on the left side of the face (Figure 1).
Intra oral image showing surgical defect with necrotic bone and necrotic slough
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The depth of the lesion showed a grayish black necrotic pseudo membranous slough with yellowish areas interspersed all over (Figure 2).
Panaromic radiograph showing multiple missing teeth and features suggestive of left maxillectomy
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Panaromic radiograph revealed multiple missing teeth (12 11 21 22 23 24 25 26 27 37) and huge surgical defect in favor of left maxillectomy (Figure 3). Paranasal sinus radiograph view showed radiolucency which is diffuse, with irregular borders involving the left maxillary antrum and deviated nasal spine and changes in favor of left maxillectomy (Figure 4).
Para nasal sinus view showing irregular diffuse radiolucency involving left maxillary sinus suggestive of osteomyelitis
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Panaromic radiograph revealed multiple missing teeth (12 11 21 22 23 24 25 26 27 37) and huge surgical defect in favor of left maxillectomy (Figure 3). Paranasal sinus radiograph view showed radiolucency which is diffuse, with irregular borders involving the left maxillary antrum and deviated nasal spine and changes in favor of left maxillectomy (Figure 4).
Computed tomography image sagittal and coronal section showing irregular radiolucency suggestive of post operative left maxillectomy, deviated nasal spine to right, left ethmoidal and sphenoidal sinusitis, Changes seen involving left pterygoid plates and posterior wall of maxillary antrum suggestive of residual changes of Osteomyelitis
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Changes seen involving left pterygoid plates and posterior wall of maxillary antrum suggestive of residual changes of Osteomyelitis (Figure 5).
PAS stained section under low power showed cellular connective tissue stroma with large non septate fungal hyphae (in black arrow) along with few areas of necrosis
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The specimen was further sent for Periodic acid Schiff staining which showed large non septate fungal hyphae branched at right angles (Figure 6).
Hematoxylin and eosin stained histopathological section showed cellular connective tissue stroma with large non septate fungal hyphae along with few areas of necrosis. focal areas of mixed inflammatory cell infiltrate were evident
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The specimen was sent for histopathological examination (Figure 7) which showed cellular connective tissue stroma composed of mixed inflammatory cell infiltrate predominantly neutrophils and lymphocytes, numerous large non septate fungal hyphae branching at right angle along with few areas of necrosis.