Original Research Paper

Maxillary Sinus Involvement In Mucormycosis-our Experience.

Abstract :

INTRODUCTION: Mucormycosis is a lethal disease in this Covid-19 Pandemic .It has more predilection to affect the patients in Immuno compromised state like Diabetes, On Prolonged Steroid therapy, and AIDS. Maxillary sinus involvement is the Most common in Mucormycosis compared to the other sinuses. OBJECTIVES: Study about the Maxillary sinus and its various walls Involvement, and to Know the extension into adjacent regions, to know about the various types of surgical treatments used for Mucormycosis clearance. STUDY DESIGN: Retrospective Study, Analytical Study.MATERIALS AND METHODS: Study was conducted in Govt Thanjavur Medical College, ENT Department from May 2021 - July 2021. Total Number of patients are 78. All cases are subjected to Clinical Evaluation, DNE, Radiological Investigation and taken for Endoscopic Sinus Surgery and other types surgery followed by Post Operative Systemic Amphotericin. All are discharged after 1week and Followed regularly every week with Endo Cleaning. RESULTS:In our Study Males are affected more in Number. Commonest Age group involved are 21-40 years. Medial wall of Maxillary sinus are commonly involved in 30 cases, followed by Palatal involvement (16 cases) and Pterygo Palatine Fossae and Infra Temporal Fossae involvement (14 cases). Pre Maxillary region and Anterolateral wall involvement in 12 cases, followed by Floor of Orbit involvement in 6 cases. Endoscopic Sinus Surgery commonly performed for 24 cases, followed by Endoscopic Medial Maxillectomy (16 cases), and Pterigo Maxillary Fossae exposure and Infra Temporal Fossae Exposure in 14 cases. Strong Positive Association present between Diabetes and Post Covid Status.DISCUSSION:Maxillary sinus and its various wall involvement in Mucormycosis is common than other sinus. Early diagnosis with clinical findings such as Nasal Obstruction, Purulent Nasal Discharge, Numbness over Infra Orbital region, Ptosis, Loosening of tooth, Trismus due to Medial Pterygoid Muscle Involvement. CT PNS plays major role in defining the Bony Landmark of Maxillary Sinus. MRI plays Vital role to identify the extent of Devitalised Tissue by that the Type of Surgical Procedure can be decided. Operated Tissue Material sent for both Histopathological Examination and Fungal Culture, by that Post Operative Amphotericin started. Adequate Glycemic Control is very important by that Disease Extension and its related complication and Mortality reduced. Regular Weekly Post Operative Follow up with Endo Cleaning is very effective in reducing Recurrence. CONCLUSION;Among all the Sinuses Maxillary Sinus is commonly involved. Early diagnosis with Supportive Radiological evidence is important for Early Surgical Debridement. Adequate Antifungal therapy is mandatory. Post operative Endo Cleaning with Step down therapy with Oral Antifungal agents is very important. Control of Predisposing factors plays vital role.

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