Acute fulminant rhino-orbito-cerebral mucormycosis: Our experience with open approach in the COVID era

Objectives: Rhino-orbito-cerebral mucormycosis (ROCM) is a quite rare and an extremely aggressive infection which can cause profound destruction of tissues. A high index of suspicion is required to diagnose and treat this infection. Although mostly occurring in diabetic or immunosuppressed patients, a sudden surge of these patients has been observed in the COVID era. Mortality is extremely high in neglected cases and can range from 40%–85% or even more. In this article, we aim to highlight patient demographics, clinical features, diagnosis, management, and outcome of fulminant ROCM in patients managed jointly by plastic surgeons and maxillofacial surgeons by the open approach. Materials and Methods: Between May 2021 and August 2021, there was a sudden upsurge of mucormycosis patients admitted in our institute (IPGME and R, Kolkata). Less severe fulminant forms of the disease were managed by the department of otorhinolaryngology by endoscopy, whereas fulminant cases with extensive involvement were managed by the department of plastic surgery in conjunction with the department of maxillofacial surgery. The surgical management involved open access to the involved tissues and resection under direct vision combined with appropriate medical management. Results: In total, we operated on eight cases of fulminant ROCM of which 4 patients were male and 4 females. Apart from this, two male patients and one female patient were also planned for extensive debridement surgery but the same could not be performed because of poor anesthetic risk. Biopsies were taken in all of these patients. Therefore, out of a total of 11 patients with fulminant ROCM, 9 patients did not survive taking the mortality rate in fulminant cases to 82%. Conclusion: ROCM can be an extremely difficult disease to treat and is associated with a very high mortality rate in fulminant cases. Early diagnosis coupled with adequate debridement and systemic amphotericin B has the prospect of salvaging patients with this dreaded disease.