Sino nasal Mucormycosis - caused by Invasive fungi which causes angio invasion and tissue invasion which leads to necrosis of tissues by causing ischaemia and spreads further through tissue invasion.
Predisposing factors : Immunocompromised status, Uncontrolled diabetes mellitus, Recently raise among COVID-19 patients and patients recovering from COVID - 19 illness.
Clinical features:
Symptoms - Swelling and/or pain over one side of cheek , swelling and/or pain of one eye, Numbness over the cheek area and/or same sided headache, Nose block, Drooping of eye lids, double vision, sudden loss of vision, Senitivity of the tooth, Ulceration in oral cavity
Signs : Swelling of cheek, proptosis, congestion of eye, Crusting in nose
On Examination :
Nose : Anterior rhinoscopy : Discharge , cruusting, bluish or blackish discolouration of turbinates.
Paranasal sinus : Tenderness ++
Eye : Restricted ocular movements, reduced visual acquity and coloured vision, chemosis, congestion, proptosis
Oral cavity and oropharynx : Crusting over the hard palate, Ulceration, Bluish discolouration of the hard palate.
Diagnosis:
Investigations :
On Diagnostic nasal endoscopy : Could be normal, Crusting and discharge in the middle meatus, ischaemic turbinates or bluish to blackish discolouration of the turbinates. If nasopharynx involved crusting seen and septal necrosed.
KOH smear : Fungal elements seen. Broad aseptate and irregular branching hyphae seen suggestive of mucormycosis.
Radiology : CECT of Nose and Paranasl sinuses
Gadolinium enhanced MRI of Paranasal sinuses
Treatment:
Surgical : Endoscopic nasal debridement +/- Orbital decompression under General anaesthesia as early as possible
Medical : Inj Liposomal Amphotericin B
