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Isolated Frontal Sinus Mucormycosis Post Covid 19-external Approaches Revisited!
Nikhil Arora1, Raman Wadhera1, Otorhinolaryngology Professor1
1Department of Otorhinolaryngology, Pt B.D Sharma, PGIMS, Rohtak, 124001 Rohtak, Haryana, Haryana India.
Background:
Isolated frontal sinus involvement in mucormycosis is seen very infrequently. Recent technological advances including image guided navigation and angled endoscopes have shifted paradigm towards minimally invasive surgeries. Open approaches are still relevant for the disease of frontal sinus with lateral extension where effective clearance cannot be obtained if approached endoscopically.
Objectives:
The objective of this study was to describe the presentation and management of patients of mucormycosis with isolated frontal sinus involvement with help of external approaches.
Materials And Methods:
The available records of the patients were retrieved and analysed. The literature, the associated contributory clinical features and management techniques were reviewed.
Results:
4 patients presented with isolated frontal sinus mucor involvement. 3 out of 4 patients had history of diabetes mellitus (75%). All patients had history of covid-19 infection (100%). 3 out of 4 patients had unilateral frontal sinus involvement and were operated by Lynch Howarth approach. Mean age of presentation was 46 years with male predominance. Bicoronal approach was used in one case with bilateral involvement.
Conclusion:
Although conservative endoscopic surgeries are preferred nowadays for frontal sinus clearance but the extensive bony destruction with lateral extension in our series of patients with isolated frontal sinus mucormycosis warranted the need for open procedures.
Insights
Open surgical approaches are crucial for treating isolated frontal sinus mucormycosis, especially with extensive lateral extension. These methods ensure effective clearance when endoscopic procedures are insufficient.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Surgical Oncology
Background:
- Isolated frontal sinus mucormycosis is a rare fungal infection.
- Minimally invasive endoscopic techniques are increasingly preferred for sinus surgeries.
- However, open surgical approaches remain vital for extensive disease, particularly with lateral extension.
Purpose of the Study:
- To describe the clinical presentation and management of patients with isolated frontal sinus mucormycosis.
- To highlight the role of external surgical approaches in these specific cases.
Main Methods:
- Retrospective analysis of patient records.
- Review of associated clinical features and management strategies.
- Literature review on frontal sinus mucormycosis.
Main Results:
- Four patients with isolated frontal sinus mucormycosis were identified.
- All patients had a history of COVID-19 infection; 75% had diabetes mellitus.
- External approaches (Lynch Howarth, Bicoronal) were used due to extensive bony destruction and lateral extension.
Conclusions:
- Despite advances in endoscopic sinus surgery, open procedures are necessary for extensive frontal sinus mucormycosis with lateral spread.
- External approaches provide effective clearance in complex cases where endoscopic access is limited.
