Mucormycosis of the temporal bone with facial nerve palsy: A rare case report

Abstract

Mucormycosis is a serious, relatively uncommon invasive fungal infection and one of the most aggressive and lethal invasive mycoses. In the region of head and neck, it usually invades nose, paranasal sinuses, orbit, intracranial structures. Mucormycosis of temporal bone with facial palsy is by far very rare and till now only one case has been reported in the literature. [1] Our experience with a diabetic patient who developed this disease and the treatment aspects in the form of surgical debridement and amphotericin B are discussed here. Figure 7: Broad, nonseptate hyphae, branching at right angled (PAS stain) How to cite this article: Sathish Kumar KN, Nishan. Mucormycosis of the temporal bone with facial nerve palsy: A rare case report.

Auricular mucormycosis complicated by parotid abscess and facial paralysis: A very rare case report

“…Other locations have been reported, including cutaneous, pulmonary, disseminated, gastrointestinal and miscellaneous [6]. For the otologic location, several hypotheses have been suggested: either a passage of the fungal spores from the sinonasal cavities to the middle ear via the eustachian tube, or their penetration to the middle ear through a perforation of the tympanic membrane, or an auricular mucormycosis invading the middle ear and the mastoid [7,8] as in our case.…”

“…Clinically, otologic mucormycosis may manifest as refractory otitis externa involving the pinna and external auditory canal giving a blackish necrotic appearance with skin scaling [8]. It may be presented as a middle ear cholesteatoma with foul-smelling otorrhea and otalgia [4,6,9].…”

“…This extension was accompanied by bacterial superinfection with parotid abscess extending to the parapharyngeal space associated with peripheral facial and vagus nerve paralysis. Among the cranial nerves, the facial nerve is the most commonly affected in auricular mucormycosis [7,8,9,10]. Vagus nerve involvement, presumably related to this parapharyngeal extension, is however unusual and would probably be the first case of this type to be reported so far.…”

“…Indeed, Aljehani M [11] reported in 2021 a case of an 18-month-old girl with undiagnosed diabetes presented with an aggressive form of auricular mucormycosis with facial nerve palsy that have fully recovered after a combination of antifungal, antibiotic, and antiviral with extensive surgical debridement. Kumar and Nishan [8] reported in 2015 a case of a mucormycosis of the external ear invading the temporal bone with associated facial palsy. The patient had surgical debridement with a modified radical mastoidectomy and facial nerve decompression combined with systemic liposomal amphotericin B.…”

“…Treatment consists of a combination of antifungal (amphotericin B at high doses of 5-15mg/ kg/day), surgical debridement and systematic control of comorbidities [5,8]. Resection of necrotic tissue reduces the fungal load and improves the penetration of antifungal agents into infected areas [12].…”