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Eckstein A, Welkoborsky HJ. [Interdisciplinary Management of Orbital Diseases]. Laryngorhinootologie 2024; 103:S43-S99. [PMID: 38697143 DOI: 10.1055/a-2216-8879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.
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Affiliation(s)
| | - H-J Welkoborsky
- Univ. Klinik für Augenheilkunde Universitätsmedizin Essen, Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Nordstadt der KRH
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Raj A, Singh P, Sadhukhan K, Chandra B, Kranti B, Kumar S, Sinha U, Kokkayil P, Bhadani PP, Sinha P, Sanepalli S, Tiwari P, Nanda J. Survival benefit of exenteration in COVID-19-associated rhino-orbital mucormycosis. Indian J Ophthalmol 2024; 72:190-194. [PMID: 38099361 PMCID: PMC10941941 DOI: 10.4103/ijo.ijo_2543_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.
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Affiliation(s)
- Amit Raj
- Department of Ophthalmology, AIIMS, Patna, Bihar, India
| | | | | | | | - Bhavana Kranti
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Subhash Kumar
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiodiagnosis, AIIMS, Patna, Bihar, India
| | | | | | - Prerna Sinha
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Sravani Sanepalli
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Pragati Tiwari
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
| | - Jayadev Nanda
- Department of Otolaryngology and Head and Neck Surgery, AIIMS, Patna, Bihar, India
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Kurup LR, Singh H, Sharma SB, Janakiram TN. Outcome of Total Surgical Debridement of Covid Associated Rhino-Orbito-Cerebral Mucormycosis Based on a New Surgical Staging System: A Cohort Study. Indian J Otolaryngol Head Neck Surg 2024; 76:298-308. [PMID: 38440527 PMCID: PMC10908694 DOI: 10.1007/s12070-023-04151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/06/2024] Open
Abstract
To propose a surgical staging system with management protocol for post-covid Rhino-orbito-cerebral mucormycosis (ROCM) with central skull base osteomyelitis. A prospective cohort study of a total of 193 post-covid ROCM patients was conducted between May 2021 and January 2022 at a tertiary care centre. Patients were assessed radiologically and staged from I to V. Follow up period was 16 months and the surgical outcome in terms of recurrent disease was assessed. A total of 193 patients (129 primary and 64 revision) were studied. Maxilla was found to be the epicenter of anterior disease (69.3%) and pterygoid wedge was noted to be the epicenter of posterior disease (85.6%). More than 65% of our patients, at the time of presentation, presented with involvement of the central skull base. Intracranial disease was noted in 13.9% of patients and the mortality rate was 6.2%. This staging system provides a systematic step-by-step protocol for the management of ROCM, with emphasis on meticulous disease clearance at the central skull base.
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Zhang KX, Gu D, Puchi C, Welch KC, Lissner GS. Combination endoscopic surgical debridement and transcutaneous retrobulbar amphotericin B for acute rhino-orbital-cerebral aspergillosis. Am J Ophthalmol Case Rep 2023; 32:101903. [PMID: 37554299 PMCID: PMC10405185 DOI: 10.1016/j.ajoc.2023.101903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE To report a case of acute rhino-orbital-cerebral aspergillosis with aggressive intracranial and orbital extension co-managed medically and surgically with endoscopic sinus debridement and multiple retrobulbar injections of amphotericin B. OBSERVATIONS A 70-year-old male patient presented via external transfer with headaches and left ophthalmoplegia concerning for severe complicated sinusitis with intracranial and left orbital spread. His history is notable for a simultaneous heart-kidney transplant three years prior on chronic immunosuppression. Ophthalmologic examination revealed complete ophthalmoplegia in the left eye with no light perception concerning for a left orbital apex syndrome. The patient was taken to the operating room twice for endoscopic sinus debridement and three separate retrobulbar injections of amphotericin B. Fungal cultures from surgical specimens grew isolated Aspergillus fumigatus. Patient's symptoms gradually improved and repeat MRI demonstrated resolution of pansinusitis, sparing left eye exenteration. CONCLUSIONS AND IMPORTANCE Multidisciplinary management of invasive fungal rhinosinusitis in the setting of profound immunosuppression poses a significant challenge. While surgical debridement remains the cornerstone approach, the achievable reduction in disease burden may be augmented by targeted retrobulbar antimicrobials.
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Affiliation(s)
- Kevin X. Zhang
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - David Gu
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Christopher Puchi
- Department of Otolaryngology – Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kevin C. Welch
- Department of Otolaryngology – Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Gary S. Lissner
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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Khorasani Esmaili P, Dabiri S, Reza Mirshekari T, Nabi Pour F, Shamsadini A, Eslami H, Damghani MA, Arabi AA, Aamizadeh M, Fani Maleki F, Gharaie N, Pouradeli S. Rhinocerebral Mucormycosis Following COVID-19 Infection in Iran. Iran J Pathol 2023; 18:116-124. [PMID: 37600568 PMCID: PMC10439752 DOI: 10.30699/ijp.2023.545953.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/30/2023] [Indexed: 08/22/2023]
Abstract
Background & Objective Mucormycosis (also called black fungus) is an opportunistic serious fungal infection caused by mucormycetes. It can occur in diabetes mellitus patients and other immunosuppressive conditions with recent predisposing factors such as maxillofacial surgery and corticosteroid usage. Methods In this study, 14 patients were referred to the otorhinolaryngology or ophthalmology ward of Shafa Hospital (Kerman, Iran) with primary symptoms of nasal fullness and facial nerve dysfunction; they were admitted to the hospital to rule out the fungal infection. An endoscopic biopsy was taken from facial sinuses or orbit, and a microscopic evaluation was performed using hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining methods to rule out mucormycosis. Results In the histopathological examination, broad-based nonseptate branching fungal hyphae were found in nasal sinuses through the endoscopic biopsy. Most of the patients had diabetes mellitus with a primary symptom of facial nerve palsy; also, most of them received corticosteroids (intravenous [IV] or intramuscular [IM] injection). All patients have recently been infected with COVID-19 (less than 1 month ago). Conclusion COVID-19 infection might be a predisposing factor for many opportunistic infections, such as fungal elements); thus, the physician should be aware of the dosage and duration of corticosteroid therapy to prevent the development of these infections.
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Affiliation(s)
- Parisa Khorasani Esmaili
- Department of Pathology, Pathology and Stem Cell Research, Afzali Pour Medical Faculty, Kerman University of Medical Science, Kerman, Iran
| | - Shahriar Dabiri
- Department of Pathology, Pathology and Stem Cell Research, Afzali Pour Medical Faculty, Kerman University of Medical Science, Kerman, Iran
| | - Touraj Reza Mirshekari
- Department of Pathology, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Fatemmeh Nabi Pour
- Department of Pathology, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Ayeh Shamsadini
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Hadi Eslami
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Mohammadad Ali Damghani
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Ali Asghar Arabi
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Maryam Aamizadeh
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Fatemeh Fani Maleki
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Navid Gharaie
- Department of Otorhinolaryngology and Head & Neck Surgery, Shafa Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Shiva Pouradeli
- Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
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