Table 1 Clinical information of the patients
Order (time) | Sex | Race | Age (years) | Primary disease | Exodontics history | Presentation of signs and symptoms | Blood routine examination | Serum biochemical test | CT(A)/MRI results | Treatment | Prognosis |
|---|---|---|---|---|---|---|---|---|---|---|---|
1(2013) | Male | Han nationality | 46 | Uncontrolled type-2 diabetes mellitus | No | Blackish necrotic skin with stink covering infraorbital region; fever; blurred vision in right eye; severe pain and swelling in the left posterior maxilla with proptosis of the left globe and ophthalmoplegia (restricted motion of eyeball); the gum in the left maxilla had severe tenderness | WBC-12.74; NEUT%-87.10; neutrophils-21.82; Hct-37.0%; PLT-93 | IL 6-93.190; PCT-0.37; BUN-32.0; ESR-40.0; HbA1c-12.3%; Scr-2.28; FBG-12.68; PPBS-64 | Diffuse mucosal thickening in both maxillary sinuses and frontal sinuses, cavernous sinus thrombosis, embolization of the maxillary artery, necrosis of the left maxilla and infraorbital area, subarachnoid hemorrhage | Surgical debridement; Antimycotic agent (NA) | Died |
2(2018) | Male | Han nationality | 27 | Hyperglycemia | Maxillary anterior left incisor | Left pupil Dilation; blackish ala nasi; a mild diffuse swelling over the left middle third of the face which was extending mediolaterally from the lateral aspect of nose to the outer canthus of the eye and superoinferiorly from the infraorbital region to 1Â cm above the corner of the mouth | WBC-25.05; NEUT%-83.90; neutrophils-9.99; Hct-38.3%; PLT-474 | IL 6-295.600; PCT-0.52; CRP-162.74; BUN-5.43; Scr-82.11 | Flow void through the left ophthalmic artery and superior ophthalmic vein, absence of enhancement within the left medial and lateral rectus muscles and along the optic nerve/sheath, left maxillary sinus and nasal mucosa thickening | Surgical debridement, removal of left nostril inferior concha, partial ostectomy of maxillary sinus; Compound fungicides (NA) | Alive |
3(2020) | Male | Kazakh | 52 | Uncontrolled type-2 diabetes mellitus | Multiple maxillary teeth | Right orbital sanguineous discharge; medial canthus malposition with necrosis extending to the ipsilateral ala nasi; dull aching pain with intermittent extra oral swelling over right maxilla and numbness of right side of upper lip | WBC-16.82; NEUT%-86.00; neutrophils-14.47; Hct-29.2%; PLT-475 | IL 6-196.300; PCT-0.28; CRP- > 90.00; DD-426.0; BUN-2.75; FBG-4.95; PPBS-133.66; Scr-35.18 | Right globe proptosis with asymmetric retrobulbar fat stranding and extensive opacification of right maxillary, ethmoid, and frontal sinuses; partial opacification of the right sphenoid sinus and erosions of the lamina papyracea | Surgical debridement with partial maxillectomy; Intravenous liposomal AmB | Recurrence died |
4(2020)* | Female | Uygur | 63 | Metabolic acidosis (diabetic ketoacidosis) | Maxillary right 1st molar, multiple extractions in mandible | Right zygomaticofacial defect by necrosis; exposed necrotic gray-colored bone in the maxillary molar region, with surrounding necrotic tissue | WBC-16.54; NEUT%-91.70; neutrophils-7.65; Hct-33.4%; PLT-119 | IL 6-27.420; PCT-0.21; CRP- > 90.00; BUN-5.95; FBG-15.69; PPBS-51.00; Scr-92.55 | The patient continued to deteriorate, was ventilated, and eventually required inotropic support. Due to persistent hypotension, we were unable to carry out repeat imaging or any debridement measures. Despite all measures, she died unfortunately on day six of this admission | ||
5(2021) | Male | Uygur | 43 | Uncontrolled type-2 diabetes mellitus | No | Grey-black-colored ala nasi; pain in the upper right posterior tooth region; edema and tenderness of the left cheek; left maxillary swelling, vestibular swelling, pain and necrosis of gum; fever | WBC-16.85; NEUT%-83.90; neutrophils-13.88; Hct-42.5%; PLT-347 | IL 6-176.600;CRP-59.6; BUN-5.30; FBG-15.21; Scr-78.30 | Opacification of the left maxillary sinus, ethmoid sinus, and frontal sinus, early stage cavernous sinus thrombosis, erosion of the anterolateral wall of left maxillary antrum with thickening of the sinus lining with moth eaten appearance of the maxillary bone seen, left facial artery and ophthalmic artery were not developed indicating embolisms existence | Specific antifungal therapy was performed****; Surgical debridement with subtotal left maxillectomy and reconstruction with a pedicled forearm flap | Alive |
6(2021)** | Female | Han nationality | 47 | Type-2 diabetes mellitus (on irregular treatment with oral hypoglycemics) | No | Ketoacidosic diabetic coma; blindness in the left eye; swelling and tenderness of the left cheek; purulent nasal discharge; extensive ulceration and necrosis involved the orbital floor, the maxilla, the hard palate and alveolar process, resulting in exposed bone and exfoliation of the anterior teeth | WBC-16.90; NEUT%-86.00; neutrophils-14.53; Hct-35.5%; PLT-114 | PCT-0.11; BUN-5.30; FBG-6.52; PPBS-33.35; Scr-104.40 | A moth-eaten appearance of the left maxillary alveolar bone and haziness of the maxillary antrum of the same side | Intravenous liposomal AmB; Surgical debridement | Died***** |
7(2021)*** | Female | Han nationality | 38 | Severe aplastic anemia, pneumonia, hypoproteinemia, hypokalemia | NM | Fever; nasal sanguineous discharge; blackly nausea; exposed necrotic gray-colored bone in right maxillary molar region, with surrounding necrotic tissue | WBC-0.09; NEUT%-undetectable; neutrophils-undetectable; Hct-22.3%; PLT-7 | IL 6-193.100; PCT-0.03; CRP- > 90.90; DD-2302.0; BUN-9.13; FBG-4.14; PPBS-21.89; Scr-27.01 | A lesion of soft tissue density in the nasal cavity, causing destruction of the nasal septum centrally, destruction of the medial walls of the antra bilaterally and perforation of the palate inferiorly, partial destruction of the floor of the orbit and ethmoidal sinus | Refused surgical recommendations (debridement, definitive palatoplasty) and was transferred to ICU to continue antifungal therapy | Died****** |