Facial translocation approach for management of invasive sinonasal aspergillosis

Aspergillosis is an uncommon fungal disease seen commonly in paranasal sinuses. It may be of noninvasive variety which is restricted to paranasal sinuses seen in healthy and immunocompetent hosts or may present as invasive form seen in immunocompromised hosts especially in diabetics and patients under long term immunosuppressant therapy. Along with paranasal sinuses invasive forms may encroach upon surrounding adjacent structures involving the orbit and extend intracranially. Orbital and intracranial involvement have a high mortality rate. Early diagnosis of the lesion and prompt aggressive management is important for better prognosis. Aggressive treatment includes surgical debulking and medical management mainly with systemic amphotericin B and other azoles. In orbito-cranial involvement, due to limited access to cranial base, it becomes difficult to surgically debulk the lesion with safety to surrounding important structures. Facial translocation approach gives adequate access to paranasal sinuses, orbit and anterior cranial base. Reported here are two cases of invasive cranio-orbito-nasal aspergillosis treated with facial translocation approach.