Antifungals used as adjuvant to surgery in AFRS (Allergic Fungal Rhinosinusitis) have shown varying success in delaying recurrences. Itraconazole has been used both as preoperative and postoperative adjuvant. This study investigates the role of itraconazole in AFRS and compares its role between preoperative and postoperative administration of the drug. Patients were randomly divided into groups as: Group 1 (n = 25), received 4 weeks itraconazole in the preoperative period and operated subsequently, Group 2 (n = 25), received 4 weeks itraconazole in the postoperative period, Group 3 (n = 50), matched patients of AFRS, who didn't receive itraconazole. All the groups received oral steroids in tapering doses staring from 1 mg/kg for 6 weeks in the postoperative period. Symptomatic (SNOT 20), radiologic (Lund Mackay, LM) scores and endoscopic (Kupferberg's NE Grades) were noted. Primary postoperative follow-up was for 24 weeks with routine CT scans and nasal endoscopies, followed by which all the patients were followed with nasal endoscopies only with CT scans when required. Both preoperative and postoperative itraconazole showed significant improvement in the SNOT, LM, and Kupferberg's grades in the follow-up period. Preoperative itraconazole therapy showed significantly better results compared to postoperative itraconazole therapy though the recurrence rates were similar in both groups. Itraconazole is a better preoperative adjunct in AFRS than postoperative.

Nasal dermoid sinus cysts are uncommon congenital anomalies that require interventions only when they present as complications. They frequently present in childhood as midline nasal masses requiring excision. They may present with intracranial as well as intraorbital extensions, making it necessary to subject the patient for proper radiological diagnosis preoperatively. Here, we present a rare case report of 28-yearold male patient who presented at our tertiary health care center with nasal dermoid cyst expanding into the frontal sinus causing proptosis and blurring of vision. The cyst was excised by combined approach, i.e. external nasal dermoid sinus tract excision and endoscopic nasofrontal sinusotomy for complete removal. The embryology, clinical history, diagnosis and surgical management are discussed.

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The repercussions of the coronavirus disease 2019 are being felt throughout the world to this day. India is one such country ravaged by the second wave of the pandemic. Here, we report two cases of post-COVID-19 mucormycotic aneurysm of the internal carotid artery (ICA), which we believe are the first of their kind in the reported medical literature. A nasopharyngeal swab for reverse-transcriptase polymerase chain reaction of the severe acute respiratory syndrome coronavirus 2 was positive for both cases. After recovering from COVID-19, both patients developed signs and symptoms suggestive of mucormycosis, which were confirmed by a fungal smear. They were managed with liposomal amphotericin B (LAmB) and other adjunctive medicines. The first patient developed a massive bout of epistaxis during surgical debulking of his fungal mass. He underwent anterior nasal packing and emergency digital subtraction angiogram which revealed an aneurysm of the right ICA which was treated by coiling of the aneurysm and parent artery occlusion of the right ICA. The second patient had a history of post-COVID-19 mucormycosis which was managed by LAmB, surgical debulking, and posaconazole. He was not in regular follow-up and did not fully complete his antifungal therapy. Later, he presented with recurrent episodes of epistaxis followed by a massive bout of bleeding from both nostrils which upon evaluation revealed a thin-walled aneurysm of the left cavernous ICA. He was treated with flow diversion and coiling. Both patients responded well and the aneurysms were successfully excluded from the circulation. Their follow-ups were uneventful.

ORAL PRESENTATIONSand no negative secondary effects were observed. Partial return to initial position of the nasal septum was observed in 20% of the patients 2 or 3 weeks after LSC. A 2-year followup did not show any posterior alterations in the position of the nasal septum. Only 5% of the patients who underwent LSC showed no improvement of nasal breathing. The positive results were obtained in 95% of the treated patients.Conclusion: LSC is a new non-invasive procedure with many advantages over the traditional traumatic surgical techniques applied to correct septonasal deformities. The high effectiveness and the safety of laser procedure are ensured by strictly meeting the appropriate correction conditions and by using a feedback control system.