Rhinocerebral mucormycosis: An analysis of probable mode of spread and its implication in an early diagnosis and treatment

Abstract

The study was done in two parts:Analysis of CT scan findings of 17 cases of mucormycosis to determine paranasal sinus, orbital and intra-cranial involvement.Cadaveric dissections of the ethmoid complex anatomy to correlate the probable mode of spread. Ethmoidal sinus was found to be the most commonly involved. The disease probably appears first here, spreads to orbit through the lamina papyracea and then through the retro-orbital region, intra-cranially. Our aim would be to diagnose the disease at the stage of ethmoid involvement. In immuno-compromised patients, if headache, peri- or retro-orbital pain or blood stained nasal discharge occur; a CT scan of the paranasal sinuses and a nasal endoscopy with biopsy from anterior ethmoids, if this area shows pathology then CT scan must be performed. If this is positive for mucormycosis, surgical debridement of the involved sinuses is to be done and Amphotericin B as intra-venous infusion and treatment of underlying condition is started.