Scholarlink

<p>Mucormycosis is a rapidly progressing invasive fungal infection caused by Mucorales of class Zygomycetes. The most common pre-disposing factors for it include uncontrolled diabetes and immunocompromised conditions. Overt use of corticosteroids in the treatment of COVID-19 patients had a synergistic effect leading to rise in the incidence of mucormycosis. Palate involvement is the most ominous feature of rhino-orbito-cerebral mucormycosis (ROCM) with incidence of 50–60%. The conventional treatment for cases of mucormycosis with palatal involvement includes extensive sinonasal debridement with palatectomy or maxillectomy followed by systemic ant-fungal therapy. We aimed to evaluate the feasibility of endoscopic debridement in palate preservation among the cases of ROCM with palate involvement. This prospective analysis was conducted at a tertiary care hospital in Bangalore over a period of 6 months (May 2021– October 2021). Our study included 31 consecutive patients who presented with signs and symptoms of mucormycosis with past history of COVID-19 and microbiologically proven mucormycosis with positive radiological signs of palatal involvement. All patients underwent transnasal endoscopic unilateral or bilateral partial maxillectomy along with debridement of sinonasal area and pterygopalatine fossa. Post-operatively all patients were treated with intravenous liposomal amphotericin-B followed by oral posaconazole. Post-operative nasal endoscopy and contrast MRI with CT of brain, orbit and PNS were performed at 3 months, 6 months, 1 year and 2 years after surgery and additional nasal endoscopic evaluation at 3rd and 4th year follow up were done to assess the disease recurrence. Total of 31 patients of COVID-19 associated mucormycosis with radiological palatal involvement were included in our study. Clinically 16 patients (51.6%) presented with normal palate, 7 (22.6%) with mucosal edema / discoloration of palate mucosa, 5 (16.1%) with palatal ulcer and 3 patients (9.7%) presented with necrotic slough with or without palatal fistula. Intra-operative findings revealed all patients (100%) had pterygopalatine fossa involvement. Successful palate preservation was possible with endoscopic debridement in 28 out of 31 cases (90.3%). The mean follow up period is 42 months (40–45 months) without any recurrence of the disease. Endoscopic debridement is a viable alternative to extensive surgery to achieve cure in cases of Rhino-Orbito-Cerebral Mucormycosis (ROCM) with palate involvement. Understanding the fact that pterygopalatine fossa is the reservoir for disease progression is crucial. Our study demonstrated conclusively that palatal preservation does not result in recurrence of the disease through meticulous, long term follow up along with clinical, radiological and microbiological evidence.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Outcomes of Palate Preservation in COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis

  • 期刊论文

  • 发表日期：

    2025年6月14日

查看全文
  • Puja Chatterjee,
  • J. G. Aishwarya,
  • Pooja Vasu,
  • K. P. Geethu,
  • Aliya Khalid,
  • Satish Nair

摘要

Mucormycosis is a rapidly progressing invasive fungal infection caused by Mucorales of class Zygomycetes. The most common pre-disposing factors for it include uncontrolled diabetes and immunocompromised conditions. Overt use of corticosteroids in the treatment of COVID-19 patients had a synergistic effect leading to rise in the incidence of mucormycosis. Palate involvement is the most ominous feature of rhino-orbito-cerebral mucormycosis (ROCM) with incidence of 50–60%. The conventional treatment for cases of mucormycosis with palatal involvement includes extensive sinonasal debridement with palatectomy or maxillectomy followed by systemic ant-fungal therapy. We aimed to evaluate the feasibility of endoscopic debridement in palate preservation among the cases of ROCM with palate involvement. This prospective analysis was conducted at a tertiary care hospital in Bangalore over a period of 6 months (May 2021– October 2021). Our study included 31 consecutive patients who presented with signs and symptoms of mucormycosis with past history of COVID-19 and microbiologically proven mucormycosis with positive radiological signs of palatal involvement. All patients underwent transnasal endoscopic unilateral or bilateral partial maxillectomy along with debridement of sinonasal area and pterygopalatine fossa. Post-operatively all patients were treated with intravenous liposomal amphotericin-B followed by oral posaconazole. Post-operative nasal endoscopy and contrast MRI with CT of brain, orbit and PNS were performed at 3 months, 6 months, 1 year and 2 years after surgery and additional nasal endoscopic evaluation at 3rd and 4th year follow up were done to assess the disease recurrence. Total of 31 patients of COVID-19 associated mucormycosis with radiological palatal involvement were included in our study. Clinically 16 patients (51.6%) presented with normal palate, 7 (22.6%) with mucosal edema / discoloration of palate mucosa, 5 (16.1%) with palatal ulcer and 3 patients (9.7%) presented with necrotic slough with or without palatal fistula. Intra-operative findings revealed all patients (100%) had pterygopalatine fossa involvement. Successful palate preservation was possible with endoscopic debridement in 28 out of 31 cases (90.3%). The mean follow up period is 42 months (40–45 months) without any recurrence of the disease. Endoscopic debridement is a viable alternative to extensive surgery to achieve cure in cases of Rhino-Orbito-Cerebral Mucormycosis (ROCM) with palate involvement. Understanding the fact that pterygopalatine fossa is the reservoir for disease progression is crucial. Our study demonstrated conclusively that palatal preservation does not result in recurrence of the disease through meticulous, long term follow up along with clinical, radiological and microbiological evidence.