Management of Post COVID Mucormycosis -Maxillectomy

ABSTRACT

Background:Mucormycosis has been increasingly described in patients with covid 19 2nd wave (delta variant) which is a highly contagious disease caused by SARS-COV-2 is the leading cause of global pandemic. AIM AND OBJECTIVES: To evaluate etiology, indications, management options and complications in patients managed with endoscopic and external maxillectomy after mucormycosis, to evaluate the incidence and distribution of cases who had extensive mucormycosis and to evaluate the outcome of the management options. Materials and Methods: This is a prospective study done in 30 cases at a tertiary care centre.All the patients were subjected to detailed history taking, clinical examination, endoscopic, radiological, pathological, microbiological investigations after taking informed consent. Patients with age group(30yrs -70yrs) who presented with ROM with extensive maxillary sinus involvement and destruction of different walls of the maxillary sinus were managed with different types of maxillectomies. Results: In this study, 30 cases of post covid rhinoorbital mucormycosis who presented to our hospital were studied, among male 24(80%) & females6 (20%).12 patients (40%) were in 5th to 6th decade and 9 patients (30%) in 4th to 5th decade.Main presenting features were unilateral cheek pain, cheek swelling, nasal obstruction, loosening of teeth, tooth ache, cheek numbness, headache, periorbital edema, visual disturbances being present in 95% of the patients.5% presented with epistaxis, ptosis, diplopia alone.90% patients were known case of diabetes milletus,10% are denovo diabetes.All the patients were subjected to routine blood investigations, microbiological, radiologicalinvestigations.(CT, MRI contrast- PNS, Orbit & Brain).Most commonly seen in males 80%. 1 patient had to undergo orbital exenteration,3 patients underwent palatal resection. Conclusion: Debridement of sinuses is necessary in all cases of mucormycosis so that the fungal reservoir could be removed and the antifungal therapy can reach the viable areas. Therefore the management of mucormycosis is individualised to each patient based on the extension of the disease and overall general conditon of the patient.