COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis: Our Institutional Experience in the Management of 300 Patients.

The use of novel therapeutic protocols and immunosuppression in COVID-19 has led to a resurgence of a rare but fatal infection, mucormycosis. It’s an angioinvasive disease causing thrombosis due to fungi mucormycetes, commonly Rhizopus Oryzae. Germination of spores in COVID-19 patients occurs due to hypoxia, hyperglycaemia, acidic medium, a high iron level, immunosuppression, prolonged hospitalization, and ventilator support. Forms of mucormycosis include rhino-cerebral, pulmonary, gastrointestinal, and disseminated. This poster illustrates the institutional experience of 300 patients, the protocol for early diagnosis, minimizing predisposing risk factors, various investigations, complex pharmacological and surgical management options, and options for rehabilitation of the rhino-orbito-maxillary form of COVID-19 associated mucormycosis.
Maxillectomy with debridement of necrosed bone, debridement of the maxillary, sphenoid, and ethmoid sinuses, retrobulbar injections of antifungals, and in terminal stages exenteration of the eye are surgical interventions that improve vascularity to the area, so that antifungals effectively reach the site. Postoperative rehabilitation options include soft tissue and ocular prosthesis, obturator, partial dentures, and pterygoid and zygomatic implants.
The 1950 Smith and Krichner criteria are considered the gold standard for nasal findings. As it is a multidisciplinary approach, physicians and dentists should be aware of the findings of this disease to avoid diagnostic and therapeutic mishaps.