Abstract
Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.
Similar content being viewed by others
References
Peterson KL, Wang M, Canalis RF et al (1997) Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope 107:855–862
Spellberg B, Edwards J Jr, Ibrahim A (2005) Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev 18:556–569
Turner JH, Soudry E, Nayak JV et al (2013) Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope 123:1112–1118
Lee DH, Yoon TM, Lee JK et al (2014) Invasive fungal sinusitis of the sphenoid sinus. Clin Exp Otorhinolaryngol 7:181–187
Gillespie MB, O’Malley BW Jr, Francis HW (1998) An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host. Arch Otolaryngol Head Neck Surg 124:520–526
Hargrove RN, Wesley RE, Klippenstein KA et al (2006) Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg 22:286–291
Radner AB, Witt MD, Edwards JE Jr (1995) Acute invasive rhinocerebral zygomycosis in an otherwise healthy patient: case report and review. Clin Infect Dis 20:163–166
Piromchai P, Thanaviratananich S (2014) Impact of treatment time on the survival of patients suffering from invasive fungal rhinosinusitis. Clin Med Insights Ear Nose Throat 7:31–34
Walsh TJ, Hiemenz JW, Seibel NL, Perfect JR, Horwith G, Lee L, Silber JL, DiNubile MJ, Reboli A, Bow E, Lister J, Anaissie EJ (1998) Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases. Clin Infect Dis 26:1383–1396
Colon-Acevedo B, Kumar J, Richard MJ et al (2015) The role of adjunctive therapies in the management of invasive sino-orbital infection. Ophthal Plast Reconstr Surg 31:401–405
Dannaoui E, Meis JF, Loebenberg D, Verweij PE (2003) Activity of posaconazole in treatment of experimental disseminated zygomycosis. Antimicrob Agents Chemother 47:3647–3650
Herbrecht R (2004) Posaconazole: a potent, extended-spectrum triazole anti-fungal for the treatment of serious fungal infections. Int J Clin Pract 58:612–624
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shah, K., Dave, V., Bradoo, R. et al. Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System. Indian J Otolaryngol Head Neck Surg 71, 259–265 (2019). https://doi.org/10.1007/s12070-018-1293-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12070-018-1293-8