Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.

Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium

Rhizopus, Mucor, and Lichtheimia (formerly Absidia) species are the most common members of the order Mucorales that cause mucormycosis, accounting for 70 to 80% of all cases. In contrast, Cunninghamella, Apophysomyces, Saksenaea, Rhizomucor, Cokeromyces, Actinomucor, and Syncephalastrum species individually are responsible for fewer than 1 to 5% of reported cases of mucormycosis. In this review, we provide an overview of the epidemiology, clinical manifestations, diagnosis of, treatment of, and prognosis for unusual Mucormycetes infections (non-Rhizopus, -Mucor, and -Lichtheimia species). The infections caused by these less frequent members of the order Mucorales frequently differ in their epidemiology, geographic distribution, and disease manifestations. Cunninghamella bertholletiae and Rhizomucor pusillus affect primarily immunocompromised hosts, mostly resulting from spore inhalation, causing pulmonary and disseminated infections with high mortality rates. R. pusillus infections are nosocomial or health care related in a large proportion of cases. While Apophysomyces elegans and Saksenaea vasiformis are occasionally responsible for infections in immunocompromised individuals, most cases are encountered in immunocompetent individuals as a result of trauma, leading to soft tissue infections with relatively low mortality rates. Increased knowledge of the epidemiology and clinical presentations of these unusual Mucormycetes infections may improve early diagnosis and treatment.

/pdf/mucormycosis-caused-by-unusual-mucormycetes-non-rhizopus-118ov4yequ.pdf

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

*국군수도병원 병리과 * Department of Pathology, Capital Armed Forces Ceneral Hospital 이 논문은 1987 년 1 2 월 30 일 접수하여 1988년 2월 8 일에 채택되었음. 하였다. 타액선조영술상 이하선 내에 분엽형 음영결손이 보였 고 이히선관의 분리 및 외측이동이 있었지만 이하선관이 불규 칙하게 좁아지거냐 끊어진 소견은 없었다(Fig.lA) . 초음파 검사상 둥글고 경계가 비교적 뚜렷한 종괴 안에 불균질의 내부에코를 보였으며 변연부 일부에서 저 에코를 관찰할 수 있었다(Fig.lB ) . 전산화단층촬영상 지방밀도의 종 괴가 이하선의 심엽에 있었고 주위 조직과 경계가 뚜렷 했으며 변연부 조영증강은 보이지 않았다 (Fig.1C). 수술소견상 3X4X3 cm 크기의 피냥형성이 잘 된종괴 가 이하선 심엽에 있었고 천엽( superf icia l lobe)을 전 방 및 외측ξ로 밀연서 일부 유착되어 있었다. 병리조직 소견상 단엽성 냥종 ( unilocular cys t) ~로 치즈같은피 지가 차 있었고 낭종의 내벽은 중층상피세포로 이루어 졌으며 그 하부에 많은 모냥과 피지선이 관찰되었다 (Fig. 1 D & E). 2 . 22 세 남자 환자로 우측 이개하$써1 4x4 cm 크 기의 약간 딱딱하고 고정되어 있S며 경계가 불규칙한 우통성 종괴를 주소로 내원하였다. 2 년전 영지손룹 크 기의 종괴가 처음 촉지되어 서서히 커졌으며 내원 8 개 윌전 종괴절제술을 받았으나 재발하였다. 초음파검사상 둥근 종괴로 비교적 경계가 명확했고 내부에는 불균등

http://synapse.koreamed.org/Synapse/Data/PDFData/1016JKRS/jkrs-24-63.pdf

Dermoid cysts of the head and neck

Oral premalignant lesions were treated by surgical excision in 61 patients. Criteria for inclusion in the study were epithelial dysplasia varying from slight to carcinoma in situ, or a non-dysplastic lesion located sublingually or on the tongue. The clinical diagnosis of the treated lesions were: erythroplakia 10, erythroleukoplakia 15, nodular leukoplakia 9, verrucous leukoplakia 9, homogeneous leukoplakia 13, and lichen planus 5. The surgically created defects were closed by direct approximation of the wound edges in 25 patients, transposition by a local mucosal flap in 9, covered with a free mucosal graft in 3, and by a free split skin transplant in 24 patients. The patients have been followed for an average period of 3.9 years after the operation. A recurrence rate of 20% was found, and 3 carcinomas developed in the follow-up period. The importance of using a surgical technique permitting histological examination of the entire lesion was documented by the finding of 4 superficial carcinomas in the excision specimen, undiagnosed in the preoperative biopsy.

Surgical treatment of premalignant lesions of the oral mucosa

Clinical presentation of zygomycosis

Oral epithelial dysplasia is a spectrum of architectural and cytological epithelial changes caused by accumulation of genetic changes, and is associated with an increased risk of progression to squamous cell carcinoma. It is a microscopic diagnosis of immense clinical importance. The initial reports of oral potentially malignant disorders with oral epithelial dysplasia transforming to oral cancer helped in understanding the nature of oral malignancies. Since then, clinical studies on oral potentially malignant disorders have combined microscopic findings of oral epithelial dysplasia to assess the malignant transformation potential of different grades of epithelial dysplasia. A significant amount of scientific literature has amassed on oral epithelial dysplasia relating to aspects of its diagnosis and management. However, the evidence base is weak as a result of the significant variability of published research. Poorly described study methods, variability in different oral epithelial dysplasia grading systems, inter- and intra-examiner variability causing issues of reliability, inadequate sample size, and inconsistent durations of follow-up are some of the methodological issues contributing to the failure to provide dependable information. Randomized clinical trials on the malignant transformation potential of oral epithelial dysplasia and its treatment outcomes are limited. This comprehensive literature review on oral epithelial dysplasia summarizes the scientific knowledge published in the scientific literature in English since its first description. The historical development, etiological factors, grading systems, diagnostic criteria, assessment of risk factors and prevention of malignant transformation, management principles of different grades of oral epithelial dysplasia (surgical and nonsurgical), recommendations on follow-up, and prognostic indicators are discussed in detail.

Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges.

The palatal injection of anaesthesia is more painful for the patient when compared to other sites of the oral cavity. Pre-cooling (cyro anaesthesia) is a well-known method practiced to reduce pain, with the use of ice or refrigerant spray on the affected site. The already known methods of ice application to the palatal site have few practical drawbacks. Therefore, this technical note highlights the use of an iced cotton bud as a novel way of providing effective pre-cooling for palatal anaesthesia. Commercially available cotton buds were dipped in clean water and then placed in the freezer. Next the frozen cotton bud was placed on the proposed anaesthetic site for one minute and anaesthesia less than 0.5CC local anaesthetic solution was delivered at a slow pace while maintaining pressure using the iced-cotton cotton bud. All patients tested showed a 0 pain response to a visual analogue scale of 0–10. This technique can be valuable to dental practitioners who are aiming for a pain free anaesthetic experience for their patients. There is potential for further research and evaluation of this technique.

The use of an iced cotton bud as an effective pre-cooling method for palatal anaesthesia: A technical note.

Zygomycosis is a rare fungal infection usually found in immunocompromised patients. It is a rapidly progressing infection with a high mortality rate. Our report describes an unusual case of rhinofacial zygomycosis due to Cunninghamella sp. in an immunocompetent patient, who presented with a slowly progressive swelling of the left cheek. An interrupted course of amphotericin B treatment caused regression of the lesion. Drug therapy was abandoned due to impairment of renal function. The patient was clinically and radiologically disease free for 2 years following cessation of therapy.

An unusual presentation of rhinofacial zygomycosis due to Cunninghamella sp. in an immunocompetent patient: a case report and literature review.

Submental dermoid cysts are uncommon midline cysts which occur due to entrapment of ectoderm between the second and third branchial arches during embryogenesis. Most dermoid cysts of the head and neck are benign, but rarely malignant transformation may occur. To the best of our knowledge, this is the first report of a carcinosarcoma arising in a submental dermoid cyst. A 42-year-old Sri Lankan Tamil man presented with a large cystic swelling in his submental region which was diagnosed as an extensive submental dermoid cyst. The cyst had been asymptomatic for 11 years but there was sudden enlargement and pain during the past 2 months. On surgical removal, a primary carcinosarcoma arising from part of the cyst wall was identified. After completion of radiotherapy, the disease was well controlled and he was disease free at 18 months. Although extremely rare, a dermoid cyst of the submental region can undergo malignant transformation. It can be successfully treated with surgical excision and radiotherapy.

/pdf/malignant-transformation-of-a-long-standing-submental-l30j1f3isq.pdf

Nadeena Sri Swarnagupta Jayasuriya

Papers

Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges.

The use of an iced cotton bud as an effective pre-cooling method for palatal anaesthesia: A technical note.

An unusual presentation of rhinofacial zygomycosis due to Cunninghamella sp. in an immunocompetent patient: a case report and literature review.

Malignant transformation of a long-standing submental dermoid cyst to a carcinosarcoma: a case report.

Oral hygiene and periodontal disease in male patients with oral cancer.