Orbital Exenteration: A Dilemma in Mucormycosis Presented with Orbital Apex Syndrome

Songu, Murat; Ünlü, Halis; Günhan, Kıvanç; İlker, Süleyman Sami; Neşe, Nalan

doi:10.2500/ajr.2008.22.3121

Cited by 42 publications

(35 citation statements)

References 26 publications

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“…However, some reports have claimed successful treatment of rhino-orbital mucormycosis. 7,8,13,18,19 Reviewing our patients' causes of death revealed complications associated with extensive mucormycosis involvement and severe comorbidity. Of the former, CNS involvement can be considered a fatal complication.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 However, following wide application of nasal endoscopy in sinus surgery, other authors have reported comparable results with frequent endoscopic debridement. 1,[11][12][13] These authors have claimed that, in selected cases, this method has less morbidity, a better surgical field of vision, and comparable results. 2,11,12 However, the poor state of most infected patients results in high mortality rates regardless of treatment type.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B

2011

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Objective: Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.Subjects and methods: Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.Results: The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.Conclusion: Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B

2011

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“…In a multi-center study, Kaya et al 20 used local amphotericin B irrigation together with different standard treatments in 4 patients, but all of those patients died. Songu et al 21 reported that in 3 cases that underwent debridement and local amphotericin B irrigation in addition to systemic treatment, spread of the fungal infection was successfully halted and none of the cases required exenteration. Konuk et al 22 reported 2 fatal cases that did not receive amphotericin B irrigation, whereas in a report of 2 non-fatal cases by Özay et al, 23 one patient received local irrigation and the other did not.…”

Section: Discussionmentioning

confidence: 99%

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases

Ş¹,

Selim²,

Kopar³

et al. 2015

tjo

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In this case report, we present the clinical findings and therapeutic outcomes of four rhino-orbital mucormycosis patients. The four patients (1 female, 3 male; age range, 55-77 years) all had diabetes mellitus and two also had chronic renal failure. All patients exhibited proptosis, sinusitis, and dark-colored lesions on the nasopharynx and/or hard palate; three patients had ipsilateral peripheral facial paralysis. Visual acuity was no light perception in the two patients with severe orbital involvement and 0.8 in two patients with limited orbital involvement. Histopathological examination of the hard palate, nasopharynx or sinus biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; both patients had complete recovery. The other two patients underwent orbital exenteration; one patient died after declining systemic treatment postoperatively. Rapid diagnosis and treatment are important for the survival of rhino-orbital mucormycosis patients. With orbital involvement, surgical debridement and systemic and local treatment with antifungal agents may help avoid mutilating surgery like exenteration.

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“…Recently, the development of both antimicrobial treatments and endoscopic sinus operation has contributed to the successful management of orbital apex syndrome by the combined therapy of antimicrobial drug and drainage by endoscopic sinus operation. 17–18 Zuma 19 descirbed that ozone aeration could disinfect Pseudomonas aeruginosa . Similarly, drainage by endoscopic sinus operation combined with antibiotics was effective for our case.…”

Section: Discussionmentioning

confidence: 99%

A Case of Orbital Apex Syndrome Due to Pseudomonas aeruginosa Infection

Kusunoki

Kase

Ikeda

2011

Clinics and Practice

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Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman) of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body.

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Orbital Exenteration: A Dilemma in Mucormycosis Presented with Orbital Apex Syndrome

Cited by 42 publications

References 26 publications

Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B

Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin B

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases

A Case of Orbital Apex Syndrome Due to Pseudomonas aeruginosa Infection

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