RECONSTRUCTIVE MODALITIES IN THE MANAGEMENT OF RHINO-ORBITO MAXILLARY MUCORMYCOSIS

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Author(s): Fatima Askari1, Saad ur Rehmand2, Shayan Shahid Ansari3, Rehan abbas4, Maira Shoaib5

Received: 01/08/2024 | Revised: 12/08/2024 | Published: 16/08/2024 | Pages: 66-71 | DOI: https://www.ejmanager.com/mnstemps/249/249-1722524063.pdf?t=1763792746


Background: Mucormycosis is considered as a medical emergency due to its rapid fatal nature. After aggressive surgical excision of facial mucormycosis, extensive defects with facial disfigurement are left behind which remain challenging for reconstructive surgeons.

Objective: Our study aimed to demonstrate different surgical modalities for reconstruction of rhino-orbito-maxillary mucormycosis.

Methodology: This retrospective study was carried out in Plastic Surgery Department of Shifa International Hospital from 1st January 2018 till 31st December 2023. A total of 14 patients were reported with mucormycosis of the head and neck region. Diagnosis was based on fungal potassium hydroxide and histopathology. Computed tomography or magnetic resonance imaging was performed to evaluate the extent of infection. After getting disease clearance by radical debridement and concomitant use of I/V amphotericin B, resultant defects were reconstructed by either pedicel flap or free flap.

Results: There were 42.8% females and 57.1 % males with mean age of 47.7. The predisposing factors were diabetes in 8 (57.1%) patients, 3 (21.4%) patients were post-covid, 1 (7.1%) was post renal transplant, 1 (7.1%) was post-acute lymphocytic leukemia, whereas 1 (7.1%) had post RTA defect with no known co-morbid. Reconstruction was done by local flaps in 14.2% and free flaps in 35.7% cases. The mean follow-up period was 17.8 months, with no recurrence of disease or flap failure.

Conclusion: Mucormycosis is a lethal disease, and its diagnosis requires high index of suspicion. Proper disease eradication is necessary for reconstruction with different autologous flaps to achieve good functional and aesthetic results.

Key words: Mucormycosis, Reconstruction, free flaps, maxillary defects, potassium hydroxide (KOH).