Endoscopic orbital exenteration in the treatment of acute invasive fungal sinusitis

Jumaily, Mejd; Faraji, Farhoud; Brunworth, Joseph

doi:10.1080/23772484.2016.1220234

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…There are multiple ways of approaching the procedure including lid sparing exenteration, extended enucleation and endoscopic orbital exenteration. 11 In our study, lid sparing exenteration was preferred due to its better cosmetic outcomes with rapid healing and earlier fitting of prosthesis. 12 Post-operative course of most patients in our study was uneventful.…”

Section: Discussionmentioning

confidence: 90%

Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study

Kumar¹,

Kumar

Alagappan³

2022

IJOOO

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Mucormycosis is an uncommon, opportunistic fungal infection. The most crucial decision in the management of rhino-orbital mucormycosis is when to advise exenteration. This study aims at understanding the pattern of cases which progressed and had extensive involvement of the entire orbital cavity with mild intra cranial extension requiring exenteration as life salvage measure in the setting of epidemic of mucormycosis in a pandemic of COVID – 19. Patients suspected or diagnosed with invasive orbital mucormycosis visiting our hospital were admitted and included in the study. CT PNS with orbit were done for all patients and MRI brain with orbit were done in patients in whom intracranial spread and involvement of optic nerve were present. Patients were started on liposomal intravenous amphotericin B (5mg/kg/day) and intraorbital amphotericin B injection when indicated and closely monitored for clinical progression. All patients were taken up for FESS and if positive for mucormycosis on histopathological examination. In cases wherever exenteration was indicated, after confirming that there was no perception of light and obtaining informed consent with psychiatric counselling patient was taken up for orbital exenteration. Lid sparing exenteration was the method of choice. A total of 41 patients out of 696(5.89%) underwent exenteration out of which 21(51.2%) were right sided and 20(48.8%) were left sided. 12 patients (29.2%) of those who had undergone exenteration did not have a history of being tested positive/ been symptomatic for COVID 19. 1 patient (2.4%) was not diabetic. All patients (100%) had sinonasal involvement (Involvement of one or more paranasal sinuses) with involvement of orbital cavity to different degrees. 4 out of 41(9.75%) patients had deteriorated and required ICU care. 1 patient succumbed to death (2.4%) due to multiple comorbidities. On histopathological examination of exenteration specimen, 2(4.87%) patients turned out to be negative for mucormycosis. In 32(78.04%) of them the socket healed well while 5(12.1%) had slough who required 2 or more sittings of sloughectomy. As mucor is angio invasive rapidly progressive highly fatal infection close monitoring for invasion into structures like apex of orbit and intra cranial spread is essential for timely intervention and decision to perform exenteration. This is crucial for arrest of progress and life salvage.

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Section: Discussionmentioning

confidence: 90%

Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study

Kumar¹,

Kumar

Alagappan³

2022

IJOOO

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“…2,13 Recently, total eyelid preserving orbital apex clearance has been described using an endoscope. 14,15 The rationale behind 'total' lid sparing exenteration is to reduce the morbidity, as it has the potential to hasten wound healing and improve functional and cosmetic rehabilitation. 4 Mucormycosis is a non-malignant disease and sparing the lids is justified under the cover of amphotericin B if gross involvement is not present.…”

Section: Discussionmentioning

confidence: 99%

Total eyelid complex sparing orbital exenteration for mucormycosis

Agarwal

Sharma

2021

Trop Doct

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Orbital exenteration is a radical surgery which involves complete removal of the orbital contents along with all or parts of the eyelid. However, the eyelid complex can be totally spared in cases of necrotising disease such as mucormycosis without compromising on exposure, or fear of devascularisation of the lids. We describe a total eyelid complex preserving orbital exenteration. Preservation of the total eyelid complex has the potential to speed up the healing process and provide dynamic functional and cosmetic rehabilitation.

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“…Existen múltiples formas de abordar el procedimiento, incluida la exenteración con preservación del párpado, la enucleación extendida y la exenteración orbitaria endoscópica [10]. Algunas investigaciones han propuesto la inyección retrobulbar en algunos casos de mucormicosis con manejo en el involucro orbitario [11][12][13][14].…”

Section: Introductionunclassified

Exenteración ocular en la mucormicosis rino-órbito-cerebral

Lugo-Machado,

Gutiérrez-Pérez,

Zazueta-Cárdenas

et al. 2024

ORL

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Introducción: La mucormicosis es una infección generada por hongos aerobios muy agresiva que pude involucrar vía aérea superior y extenderse a estructuras adyacentes. Objetivo: Analizar la asociación entre el deceso y la exenteración ocular en pacientes con mucormicosis rino-orbito-cerebral. Método: Se analizaron los aspectos clínicos y desenlace de los pacientes con mucormicosis rino-orbito-cerebral. Se empleó estadística descriptiva, se empleó Ji cuadrado para asociación, para riesgo se utilizó odd ratio, considerando como significativo con un valor de p≤0.05. Resultados: De 45, 11 no cumplieron los criterios de inclusión, no se encontraron asociaciones entre sexo, diabetes con otras comorbilidades, los estadios de la MROC y deceso, la infección por COVID-19, ni la hemoglobina glucosilada (HbA1c). Sin embargo, la lisis ósea en la tomografía (p=0.001), el tipo de procedimiento quirúrgico (p=0.002), y la exenteración ocular (p=0.001) se asociaron significativamente con deceso. Se encontraron diferencias entre los niveles de proteína C reactiva (PCR) (p=0.035), la velocidad de sedimentación globular (VSG) (p=0.056), y el recuento absoluto de neutrófilos (p=0.000) con muerte. Discusión: La decisión de exenteración ocular, es un aspecto complejo en los pacientes con MROC, existen autores quienes señalan que el impacto psicológico es significativo en una proporción sustancial de pacientes. Conclusiones: Las únicas características asociadas a deceso en pacientes con MROC en el estudio fueron la presencia de lisis ósea en la tomografía y la exenteración ocular.

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Endoscopic orbital exenteration in the treatment of acute invasive fungal sinusitis

Cited by 5 publications

References 19 publications

Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study

Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study

Total eyelid complex sparing orbital exenteration for mucormycosis

Exenteración ocular en la mucormicosis rino-órbito-cerebral

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