Currently, the relevance of the issues of diagnosis and treatment of invasive fungal diseases has increased significantly due to the pandemic of a new coronavirus infection COVID-19 and the massive use of corticosteroids for the treatment. The key success factors in the outcome of invasive fungal diseases are early diagnosis and treatment, including the applying of an adequate systemic antifungal therapy and surgical treatment. Extensive areas of mycotic lesions of the facial bones and paranasal sinuses are lifethreatening conditions due to anatomical proximity to brain structures and a high risk of dissemination of I invasive fungal diseases with a fatal outcome. The objective of this work was to study the risk factors, possible pathogenesis, diagnosis and treatment strategy of invasive fungal diseases of the orofacial region in convalescents of COVID-19. We present case-series data on six patients in the clinics of maxillofacial surgery and otorhinolaryngology of the Pavlov First Saint Petersburg State Medical University over the period of 2021–2022. Predisposing factors, clinical and radiological symptoms, features of diagnosis, therapy and surgical strategy were analyzed. The presented observations confirm the relevance and danger of complications after a COVID-19 in the form of the development of invasive fungal diseases with damage to the maxillofacial region caused by mucormycetes and Aspergillus spp., as well as importance of early diagnosis and treatment.

INTRODUCTION: Since 2020, the number of patients with complications after a new coronavirus infection (COVID-19) has increased, including mycoses. Mucormycosis ranks third in the frequency of detection among invasive mycoses in patients with reduced immunity. Acute and chronic invasive fungal rhinosinusitis is the most severe and dangerous variant of the disease.OBJECTIVE: To analyze the features of the osteodestructive process of invasive mucormycosis, its relationship with blood supply, the dynamics of the process under the influence of treatment.MATERIALS AND METHODS: The study evaluated changes in the bone structures of the skull, soft tissues of the facial region, brain, and thorax in a group of 10 patients (62.3±11.4 y.o.) examined in the clinic of maxillofacial surgery and the clinic otorhinolaryngology in the post- covid period. The results of cone-beam computed tomography (Sirona) of the maxillofacial region, Xray computed tomography Optima 540 CT (General Electric) of the maxillofacial region and thoracic cavity organs, magnetic resonance imaging (GE Signa HDxt) of the brain and maxillofacial region with intravenous administration of a paramagnetic contrast agent were analyzed.RESULTS: In all cases, osteolytic lesions as a classical manifestations of invasive mucormycosis, were revealed in: alveolar processes of the upper jaws and walls of the maxillary sinuses in 100% of cases; palatine processes — 90%; nasal septum, walls of the ethmoid sinuses and walls the orbits — 70%; walls of the sphenoid sinus — 50%; pterygoid processes and zygomatic bone — 40%; the body of the sphenoid bone, nasal bones, frontal bones — 30%; the alveolar part of the mandible and temporal bone — 10%. All patients underwent surgery with resection of the affected bones — 100%, while 7 out of 10 patients received antimycotic therapy. When assessing the revealed changes in dynamics in all patients in the long-term postoperative period, sclerosis of small foci of destruction, a decrease in the extent of bone defects, a decrease in the size of sequesters, hyperostosis of the walls of the paranasal sinuses, cells ethmoid sinuses of the after sequestrectomy were noted. There were no fatal cases among the 10 patients we observed at the time of publication.CONCLUSION: The combination of anatomical features and the state of blood supply contributes to the development of invasive mucormycosis of the bones of the facial skull and the RCT data help with determining treatment tactics, the volume of surgery, and assessing dynamics in the early and long-term postoperative period.

There are a number of publications in the literature that describe osteometric measurements of the styloid process of the temporal bone. Most studies are based on the results of direct measurements of bone preparations of the skulls; however, modern radiation research allows you to get a complete picture of the shape, relative position with other anatomical structures. Obtained results are rare. The purpose of the study was to present the results of measurements of the styloid process of the temporal bone and its relationships with other parts of the stylo-hyoidal complex obtained by analyzing images of multi-spiral computed tomography in patients without pathology of this anatomical zone. The length and width of the process, the distance to the small horn of the hyoid bone, and the height and weight of patients depending on age were measured. It has been established that multi-spiral computed tomography is an accurate method for determining the parameters of the styloid process. No statistically significant relationships between the anatomical parameters of the styloid process, other elements of the stylo-hyoidal complex, gender, height and age of the examined patients were found.