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Management of COVID-19 associated rhino-orbital mucormycosis and reconstructive options for the resulting extensive defects: a case report
Background: With the emergence of coronavirus disease 2019 (COVID-19), fungal co-infections have become increasingly prevalent among critically ill patients, particularly those on prolonged hospital stays or requiring mechanical ventilation. Mucormycosis, an angioinvasive fungal infection, poses a significant challenge in immunosuppressed individuals and those with predisposing factors such as diabetes, with or without ketoacidosis. Rhino-orbital mucormycosis represents the most aggressive and frequently encountered form of this disease, often resulting in extensive surgical resections and debilitating defects. In this report, we present three cases of COVID-19-associated rhino-orbital mucormycosis (CROM), including a unique instance in a non-diabetic patient. Notably, we employed a modified intra-oral approach for surgical interventions, deviating from the commonly practiced extra-oral incisions described in the literature. Additionally, the authors c onduct a literature review to explore reconstructive and rehabilitative options for CROM patients, with the ultimate aim of establishing consensus guidelines in this domain. Case Description: Three patients presented with complaints of unilateral facial swelling, toothache, tooth mobility, and purulent discharge from the right upper posterior tooth region. All patients tested positive for COVID-19, with two of them having a history of type II diabetes mellitus (Cases 1 and 2), while one patient had no known comorbidities. The diagnosis of CROM was confirmed through computed tomography of paranasal sinuses (CT-PNS), magnetic resonance imaging (MRI), direct nasal endoscopy, and biopsy. Aggressive surgical debridement, employing functional endoscopic sinus surgery (FESS) and bilateral maxillectomy, was performed. Treatment included Inj. liposomal amphotericin B (5 mg/kg body weight), followed by posaconazole 300 mg tablets. The patients exhibited favourable tolerance to the procedure, and post-operative follow-up over a period of 6 months demonstrated satisfactory healing. Conclusions: CROM should be considered even in patients lacking common risk factors. The utilization of an intra-oral approach for surgical debridement, while preserving the palatal mucoperiosteum, offers advantages by reducing complications like nasal regurgitation and crustations within the maxillary cavity, and improved fitting of future prostheses. Despite the availability of various prosthetic and reconstructive strategies for extensive maxillectomy defects, the current approaches predominantly rely on expert opinions rather than established evidence-based recommendations. Therefore, there is an evident need to develop clear consensus guidelines to manage these patients. © AME Publishing Company.
Authors : Shetty S.K.; Shukla V.
Source : AME Publishing Company
Article Information
| Year | 2024 |
| Type | Article |
| DOI | 10.21037/fomm-22-66 |
| ISSN | 2664777X |
| Volume | 6 |
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