Study of Clinicoepidemiology and Surgical Complications in Acute Invasive Fungal Rhinosinusitis

Abstract

To study clinicoepidemiology and surgical complications in acute invasive fungal rhinosinusitis. Retrospective observational study carried in GMC Akola from February 2021 to April 2022. Detailed history and clinical examination, nasal endoscopic biopsy or swab for KOH and fungal culture was taken. CECT/MRI PNS + Orbit + Brain was done. All patients underwent surgery and tissue sample send for histopathological examination. Total 146 patients included in study with M:F ratio 1.7:1. Most affected age group was between 40 and 60 years. 107 (78.6%) patients had history of COVID-19.Mucorale is most commonly found fungal species (90.4%) followed by aspergillus (2.7%) & mixed species (6.8%). Diabetes Mellitus is most common comorbidity. Intraoperative complications were bleeding (72.60%), CSF leak (4.1%), orbital hematoma (0.68%), nasolacrimal duct trauma (2.05%), periorbital hematoma (0.68%). Post operative complications like synechiae (56.16%), OAF (45.89%), hypoesthesia (25.34%), decreased vision (16.43%), facial pain (20.54%), facial deformity (20.54%), diplopia (6.8%), headache (30.13%), anosmia (39.72%), dental pain (20.54%), earache (9.58%), hyposmia (45.89%), periorbita ecchymosis (0.68%), residual disease (16.10%), recurrence (2.05%), death (2.05%) was observed. Prompt surgical debridement of devitalized tissue and early adequate dosage of antifungal (inj. Amphotericin-b) treatment are necessary as delay in surgical debridement and treatment can worsen the prognosis of disease. Among all complications faced maximum were manageable with early interventions but few of them were inevitable due to extensive nature of disease.

A Systematic Review of the Therapeutic Outcome of Mucormycosis

“…However, surgical treatment is not free of complications. A retrospective observational study evaluating surgical complications of 146 patients with acute invasive fungal rhinosinusitis, most with mucormycosis, showed that bleeding is the most common intraoperative complication, followed by cerebrospinal fluid leak, orbital hematoma, nasolacrimal duct trauma, and periorbital hematoma [ 45 ]. A number of postsurgical complications including synechiae, hypoesthesia, decreased vision, facial pain, facial deformity, diplopia, headache, anosmia, dental pain, earache, hyposmia, and periorbital ecchymosis have been documented [ 43 ].…”

Early trends of secondary acquired nasolacrimal duct obstruction in COVID-19 associated sino-orbital mucormycosis: SALDO update study (SUP) – Paper IV

“…Several factors attributed to this surge include underlying uncontrolled diabetes mellitus, injudicious use of steroids, decreased immune response, diabetic ketoacidosis, hypoxic milieu, and prolonged hospitalization with or without ventilators. 1 , 2 The ROCM treatment consisted of surgical debulking of all the affected tissues followed by long-term medical management with systemic anti-fungal medications. 3 , 4 , 5 Surgical debulking may involve but is not restricted to the sinuses, maxilla, pterygopalatine fossa, infratemporal fossa, orbit, and other extracranial sites.…”

“… 3 In most cases, the nasal and sinus debridement was performed using Denker's approach, where the nasolacrimal duct was deliberately cut as a part of the surgery, a possible cause for iatrogenic secondary acquired lacrimal duct obstruction (SALDO). 1 Nevertheless, the extensive involvement of the nose, sinus, and orbit with mucormycosis can initiate inflammation and fibrosis, or cause a direct invasion of the nasolacrimal ducts or more commonly, can be secondary to the iatrogenic trauma during debridement. The current report presents a series of five cases who, after complete surgical and medical treatment of ROCM, presented with complaints of epiphora.…”