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January 27, 2023


Indian J Otolaryngol Head Neck Surg


http://www.ncbi.nlm.nih.gov/pubmed/36684821?dopt=Abstract

Study of Clinicoepidemiology and Surgical Complications in Acute Invasive Fungal Rhinosinusitis.

Authors

Chaurpagar R, Chiplunkar B, Doifode P, Athawale N
Indian J Otolaryngol Head Neck Surg. 2023 Jan 13:1-8.
PMID: 36684821.

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.