DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20220472

Management of rhino-orbital-cerebral mucormycosis: our experience

Rameshwar T. Pawar, A. Z. Nitnaware, Seema Patel, Pradyumna Singh, Dharmik Rana, Himani Bhatt

Abstract


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.


Keywords


Mucormycosis, Endoscopic sinus surgery, Amphotericin B, Posaconazole

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