Endonasal treatment of acute invasive fungal rhinosinusitis in immunocompromised pediatric hematology-oncology patients.
OBJECTIVE
Acute invasive fungal rhinosinusitis (AIFR) is an aggressive fungal infection in immunocompromised patients with high mortality rates. The aim of this study is to present our experiences on endonasal treatment in immunocompromised pediatric hematology-oncology patients with AIFR.


METHODS
Thirteen pediatric hematology-oncology patients treated for AIFR between March 2006 and December 2011 were analyzed retrospectively. We reviewed the following data for all patients: age, gender, predisposing disease, initial symptoms, pathological diagnosis, microbiological results, laboratory findings, surgical procedure, number of operations and treatment outcomes.


RESULTS
Nine of 13 patients with lesions confined to sinonasal cavity were operated with endoscopic approach. Open surgery was performed in four patients, three of them had palatal and buccal lesions and one had facial skin involvement. Endoscopic approach was also used for sinonasal lesions of these four patients. A total of 7 patients died: 4 patients with progression of the underlying disease, 2 patients with sepsis and 1 patient due to renal failure. Survival rate in surgically treated patients was found 46% (6/13 patients).


CONCLUSIONS
Endonasal endoscopic approach is both feasible and efficient technique, also enables excellent local control with less morbidity compared to open surgery. This approach is suitable for patients who are diagnosed in the early stages of AIFR and also presents a less traumatic option for patients with poor health status. Open surgical procedure should be preferred in patients with disease extending out of the sinonasal cavity.
Çukurova University, Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Adana 01330, Turkey. ozgur_tarkan@yahoo.com
Ozgür
O
Tarkan
Barbaros
B
Karagün
Süleyman
S
Ozdemir
Ulkü
U
Tuncer
Ozgür
O
Sürmelioğlu
Erdinç
E
Cekiç
Karahan
K
Kara
D000208:Acute Disease; D000293:Adolescent; D000741:Anemia, Aplastic; D001228:Aspergillosis / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute; D008228:Lymphoma, Non-Hodgkin; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis; D009503:Neutropenia; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D012189:Retrospective Studies; D012220:Rhinitis / Q000382:microbiology* / Q000601:surgery*; D012852:Sinusitis / Q000382:microbiology* / Q000601:surgery*; D013921:Thrombocytopenia / Q000150:complications