Download PDF
CC BY 4.0 · Int Arch Otorhinolaryngol 2025; 29(01): s00441791645
DOI: 10.1055/s-0044-1791645
Original Research

Endoscopic Orbital Clearance/Debridement: A Potential Substitute for Orbital Exenteration in Rhino-orbital Mucormycosis

Ahmed Hassan Sweed 
1   Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
,
Ahmed Mohammad Anany
1   Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
,
Atef Hussein
2   Department of Ophthalmology, Faculty of Medicine, Zagazig University, Egypt
,
Waleed Nada
2   Department of Ophthalmology, Faculty of Medicine, Zagazig University, Egypt
,
Mohamed Eesa
1   Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
,
Ismail Elnashar
1   Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
,
Mohamed Mobashir
1   Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
,
Enas Moustafa Ibrahim
3   Department of Diagnostic Radiology, Faculty of Medicine, Zagazig University, Egypt
,
Mohammed Elsayed Elmaghawry
1   Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
› Author Affiliations Funding The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Mucormycosis is an aggressive, lethal fungal infection affecting the nasal and paranasal territory in immunocompromised patients. Orbital involvement is not uncommon and may require orbital exenteration.

Objectives The management of orbital involvement in invasive fungal sinusitis is challenging, ranging from conservative retrobulbar amphotericin B injection in the early stages to orbital exenteration in late stages. Endoscopic endonasal debridement is a minimally invasive technique used to manage orbital fungal involvement in the late stages.

Methods Endoscopic endonasal orbital clearance was performed to manage late-stage orbital invasive fungal infection (≥ stage 3c) or after failure of retrobulbar amphotericin B injection with no light perception. Removal of the lamina papyracea (LP) and incision of the periorbita were done to expose all the necrotic intraorbital content in the extra and intraconal spaces. A microdebrider was utilized to debride necrotic fungal infected tissue until a healthy vascularized plane was reached. Gelfoam (Pfizer Inc., New York, NY, United States) soaked in amphotericin B was applied as an adjunctive step to deliver antifungal medication to the orbital content.

Results Fourteen patients were included in the study, 9 of whom were male and 5 female, with a mean age of 58.5 years. Eleven patients showed no evidence of disease progression (complete recovery and cessation of medical treatment). Two patients died 15 days after the surgery. The last patient developed frontal lobe abscess but has been treated with double antifungal medication.

Conclusion Endoscopic endonasal orbital debridement could be an effective method to treat late-stage orbital fungal infection without jeopardizing the patient's life.

Level of Evidence: 4.

Keywords

COVID-19 - mucormycosis - debridement

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding authors upon reasonable request.


Ethical Approval

Approval was obtained from the Zagazig University Institutional Review Board committee. The procedures used in the present study adhere to the tenets of the Declaration of Helsinki.


Consent to Participate and Publish

Informed consent was obtained from all individual participants included in the study. The authors affirm that human research participants provided informed consent for publication of their data.




Publication History

Received: 28 March 2024

Accepted: 21 August 2024

Article published online:
23 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Bibliographical Record
Ahmed Hassan Sweed, Ahmed Mohammad Anany, Atef Hussein, Waleed Nada, Mohamed Eesa, Ismail Elnashar, Mohamed Mobashir, Enas Moustafa Ibrahim, Mohammed Elsayed Elmaghawry. Endoscopic Orbital Clearance/Debridement: A Potential Substitute for Orbital Exenteration in Rhino-orbital Mucormycosis. Int Arch Otorhinolaryngol 2025; 29: s00441791645.
DOI: 10.1055/s-0044-1791645
 

  • References

  • 1 Sweed AH, Mobashir M, Elnashar I. et al. MRI as a road-map for surgical intervention of acute invasive fungal sinusitis in Covid-19 era. Clin Otolaryngol 2021; ;•••: Epub ahead of print
    CrossrefPubMedSearch in Google Scholar
  • 2 Cornely OA, Alastruey-Izquierdo A, Arenz D. et al; Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19 (12) e405-e421
    CrossrefPubMedSearch in Google Scholar
  • 3 Soni K, Das A, Sharma V. et al. Surgical & medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes - a tertiary care center experience. J Mycol Med 2022; 32 (02) 101238
    CrossrefPubMedSearch in Google Scholar
  • 4 Honavar SG. Code Mucor: guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol 2021; 69 (06) 1361-1365
    CrossrefPubMedSearch in Google Scholar
  • 5 Metwally MI, Mobashir M, Sweed AH. et al. Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging,. Academic Radiology, 2021 , ISSN 1076–6332, https://doi.org/10.1016/j.acra.2021.12.007
    CrossrefSearch in Google Scholar
  • 6 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
    CrossrefPubMedSearch in Google Scholar
  • 7 Afroze SN, Korlepara R, Rao GV, Madala J. Mucormycosis in a diabetic patient: a case report with an insight into its pathophysiology. Contemp Clin Dent 2017; 8 (04) 662-666
    CrossrefPubMedSearch in Google Scholar
  • 8 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
    CrossrefPubMedSearch in Google Scholar
  • 9 Gangneux JP, Bougnoux ME, Dannaoui E, Cornet M, Zahar JR. Invasive fungal diseases during COVID-19: We should be prepared. J Mycol Med 2020; 30 (02) 100971
    CrossrefPubMedSearch in Google Scholar
  • 10 Choksi T, Agrawal A, Date P. et al. Cumulative mortality and factors associated with outcomes of mucormycosis after COVID-19 at a multispecialty tertiary care center in India. JAMA Ophthalmol 2022; 140 (01) 66-72
    CrossrefPubMedSearch in Google Scholar
  • 11 Sen M, Honavar SG, Bansal R. et al; members of the Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC) Study Group. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol 2021; 69 (07) 1670-1692
    CrossrefPubMedSearch in Google Scholar
  • 12 Pathak M, Sahu V, Arora RD. et al. Retrobulbar Amphotericin B Injection in Curbing the Progression of COVID Associated Rhino-orbital Cerebral Mucormycosis: A Retrospective Case Series. Indian J Otolaryngol Head Neck Surg 2022; 74 (Suppl. 02) 3352-3358
    CrossrefPubMedSearch in Google Scholar
  • 13 Sharifi A, Akbari Z, Shafie'ei M. et al. Retrobulbar injection of amphotericin B in patients with COVID-19 associated orbital mucormycosis: a systematic review. Ophthalmic Plast Reconstr Surg 2022; 38 (05) 425-432
    PubMedSearch in Google Scholar