Diagnostic Tools in COVID-19-Associated Mucormycosis: Do We Need 3-dimensional Computed Tomography

ABSTRACT

Introduction: Early detection of COVID-19-associated mucormycosis (CAM) is critical for accurate staging and optimal treatment. Three-dimensional computed tomography (3D CT) reconstruction of the face has recently come up as a newer diagnostic tool in CAM. Method(s) This clinical study was done to evaluate the efficacy of 3D CT in diagnosing and managing CAM. We compared 3D CT reconstruction with conventional 2D CT. One hundred twenty-three confirmed cases of mucor were subjected to 3D CT reconstruction in addition to contrastenhanced magnetic resonance imaging after comprehensive clinical workup. The involvement of maxillary walls, alveolus, palate, orbital floor, zygomatic process, and other facial skeleton were noted. The plan of management was decided after assessing the extent in 3D CT. Result(s) Anterior maxillary wall was found to be the commonly involved (9.7%). Involvement of the lateral maxillary wall was noted in 8.1% of subjects. Sixty-seven subjects underwent endoscopic endonasal debridement, 19 underwent total maxillectomy, 3 had infrastructure maxillectomy, 8 had orbital exenteration, and 12 had combined endoscopic and open surgeries. In 21 patients (17%), open surgery was done based on additional 3D CT findings at the first instance and revision surgeries were avoided. Conclusion(s) 3D CT face was found to be superior to conventional CT in diagnosing the extent of disease and plays an important role in preoperative surgical planning of CAM. Minor cortex erosions are not picked up by conventional CT;it also does not show finer details and leaves the surgeon imagining the disease extent. 3D CT decreases delay in diagnosis, facilitates the surgical plan, and reduces the need for multiple surgeries. It is a valuable tool in the assessment of revision cases and follow-up.