Mucormycosis, also called as Black Fungus has arisen as a nightmare during COVID-19 pandemic. It is caused by exposure to mucor mould which is commonly found in soil, plants, manure, decaying fruits and vegetables and even in the nose and mucus of healthy people. It mainly affects diabetic and other immunocompromised patients. The number of cases reported of this deadly fungus has increased during the COVID-19 pandemic. It has been probably triggered by the use of steroids, a lifesaving treatment for severe and critically ill COVID-19 patients and also said to be due to the increased blood sugar level and immune compromise induced by COVID-19 virus itself. The fungal organism compromises the blood supply to bones and soft tissues of oro-facial region leading to necrosis of these structures, known as fungal osteomyelitis of jaws and sinuses.

SDM Craniofacial Surgery and Research Centre is a state-of-art head and neck surgery hospital located in the campus of SDM College of Dental Sciences and Hospital, Dharwad. The craniofacial centre received the first Black fungus patient as early as June 2020. Since then, the team of 12 maxillofacial surgeons and postgraduates at the centre under the guidance of Dr. Niranjan Kumar, Director, SDM Craniofacial Surgery and Research Centre and head of the department Dr. Anil Kumar Desai has relentlessly treated more than 60 patients in last one year, 50 amongst them in last three months only. The treatment protocol followed is standardised and were set much before the pandemic. Since we already had the protocols in place, management of this deadly disease was not new to the team. These protocols were updated regularly based on the clinical observation and treatment outcome of much aggressive black fungus cases reported in COVID-19 recovered patients compared to the one reported to us before the pandemic. All the patients who underwent treatment in the centre were cured completely with nil mortality.

Patients commonly present with severe dental pain and/or mobility, pus discharge, numbness over the check region on affected side, necrosed bone in the oral cavity, nasal stuffiness, bulged eyes, and headache. Early diagnosis of the infection by clinical examination, specific tests for fungal detection and CT scan examination has helped in yielding good treatment outcome. Patient’s physical, mental, and systemic conditions were carefully taken care at SDM. Necrotic upper jaw along with involved teeth and nearby structures including infected sinus mucosa were removed surgically. Aggressive surgical management of removing complete or a part of the involved jaw and related structures were really important to put a stop to the progress of the infection. Medical management included injection Liposomal Amphotericin B up to a maximum dose of 2 grams administered according to the severity of the infection. Multidisciplinary approach was adopted in management which included a team of ENT surgeons, opthalmologists, radiologists, physicians, neursurgeons and prosthodontists. Dental rehabilitation of the treated patients is being planned and carried out in the centre in association with department of prosthodontics. Any patients experiencing the above described symptoms should consult an Oral and Maxillofacial Surgeon as well as ENT surgeon promptly.