Management of rhino-orbital-cerebral mucormycosis: our experience


  • Rameshwar T. Pawar Department of ENT, GMC, Nagpur, Maharashtra, India
  • A. Z. Nitnaware Department of ENT, GMC, Nagpur, Maharashtra, India
  • Seema Patel Department of ENT, GMC, Nagpur, Maharashtra, India
  • Pradyumna Singh Department of ENT, GMC, Nagpur, Maharashtra, India
  • Dharmik Rana Department of ENT, GMC, Nagpur, Maharashtra, India
  • Himani Bhatt Department of ENT, GMC, Nagpur, Maharashtra, India



Mucormycosis, Endoscopic sinus surgery, Amphotericin B, Posaconazole


Background: Mucormycosis is a rapidly progressive, angio-invasive fungal infection caused by the fungus belonging to mucoraceae family that has predilection for the paranasal sinuses and adjacent mucosa. Of all the forms of mucormycosis, rhino orbital cerebral (ROCM) is the most commonand most aggressive. Our aim is to study the diagnosis, investigation, medical and surgical management of ROCM.

Methods: A retrospective study of 273 patients was conducted at the department of ENT, government medical college and hospital, Nagpur between March 2021 to August 2021. Data was collected and analysed.

Results: Total 273 patients of mucormycosis were included in this study. There was total 197 (73%) males and 76 (27%) females, patient belonged to age group between 16 to 74 years. Diagnosis was made on the basis of clinical presentation and typical radiological and histopathological findings. On radiography, disease may be limited to a single sinus or involve multiple sinuses. In our study maxillary sinus was most commonly involved sinus 265 (97.06%) followed by ethmoid sinus 258 (94.50%), sphenoid sinus 209 (76.55%), frontal sinus 88 (32.23%). Extension to pterygomaxillary and infratemporal fossa was seen in 160 (58.60% patients), frontal bone involvement in 7 (2.56%), intra-orbital extension 67 (24.54%), intracranial extension 43 (15.75%), mandibular erosion 4 (1.46%).

Conclusions: Rhino orbital cerebral mucormycosis is a life-threatening fungal infection, with very high mortality. Interprofessional management typically consists of intervention from an infectious disease specialist, otorhinolaryngologist, microbiologist, ophthalmologist, and paramedical staff, all working hand in hand for better achievement of results. Early diagnosis and intervention surely achieve better prognosis.


Hosseini SM, Borghei P. Rhino-cerebral mucormycosis: pathways of spread. Eur Arch Otorhinolaryngil. 2005;262(11):932-8.

Ashley Hagen MS. COVID-19-Associated Mucormycosis: Triple Threat of the Pandemic. Am Society Microbiol. 2021.

Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B et al. 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. Lancet Infect Dis. 2019;19:e405-21.

Dannaoui E. Antifungal resistance in Mucorales. Int J Antimicrob Agents. 2017;50(5):617-21.

Chakrabarti A, Singh S. Management of Mucormycosis. Curr Fungal Infect Rep. 2020;14:348-60.

Ajith Kumar AK. Rhino-orbital Cerebral Mucormycosis, Stat Pearls. 2021.

Asdaq SMB, Rajan A. Identifying Mucormycosis Severity in Indian COVID-19 Patients: A Nano-Based Diagnosis and the necessity for critical therapeutic intervention. Antibiotics (Basel). 2021;10(11):1308.

Anagha RJ, Mridula MM. CT and MRI Findings of Invasive Mucormycosis in the setting of COVID-19: Experience from a single center in India. Am J Roentgenol. 2021;217(6):1431-2.






Original Research Articles