Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndrome.
BACKGROUND
Mucormycosis is an uncommon, rapidly progressive, commonly fatal, opportunistic, fungal paranasal sinus infection. The most critical decision in the management of rhino-orbital mucormycosis is whether the orbit should be exenterated. The literature fails to provide a broad base of information of how physicians determine the need for exenteration in daily practice. The decision for exenteration often depends on the judgment of the treating otolaryngologist. The authors report their experience and outline that orbital exenteration may not be mandatory in all cases of rhino-orbital mucormycosis.


METHODS
The medical records from Celal Bayar University Medical Faculty Department of Otorhinolaryngology/Head and Neck Surgery were retrospectively searched from 1995 to 2007 for three cases with rhino-orbital mucormycosis, treated without orbital exenteration.


RESULTS
All patients with rhino-orbital mucormycosis who were treated without exenteration survived.


CONCLUSIONS
The favorable outcome was attributable to rapid correction of the underlying medical condition; wide local excision and debridement of all involved and devitalized sinonasal and periorbital tissue, while establishing adequate sinus and orbital drainage; daily endoscopic assessment with multiple sinus debridement when necessary; daily irrigation of the involved areas; and high-dose i.v. amphotericin B.
Songu
Murat
M
Department of Otorhinolaryngology/Head and Neck Surgery, Celal Bayar University Hospital, Manisa, Turkey. songumurata@yahoo.com
Unlu
H Halis
HH
Gunhan
Kivanc
K
Ilker
S Sami
SS
Nese
Nalan
N
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B