Subjects and methods
This is a prospective, single-centre, interventional study at “Blinded
for review”. This cross-sectional study has included the patients
presenting with recurrence in the frontal bone following the initial
treatment of covid associated mucormycosis by surgical debridement and
systemic amphotericin B . ten patients admitted and treated at our
centre from 1st July 2021 to 30th September 2021 were
included in the data analysis. A detailed proforma to record the
demographic data, clinical presentation, investigations, points in
pathogenesis, and pathogenesis of the management in each patient. The
data analysis was performed using IBM SPSS Statistics for Windows,
Version 25.0. Armonk, NY: IBM Corp. The Institutional Research Cell
approval was obtained for the study under reference
OW/RC/AIIMS-RPR/2021/571. STROBE guidelines has been utilized for data
reporting.
A check nasal endoscopy was done to look for other focus of infection in
the sinonasal cavity. A complimentary cross sectional radiological
imaging was performed to look for the disease extent and to determine
the intracranial spread. The patients were planned for appropriate open
surgical debridement based on the disease extent. An intraoperative
fungal KOH smear was performed to determine the mucormycosis. After the
ablative surgery, a definitive permanent plastic reconstruction
procedure was deferred due to the possibility of disease recurrence and
contaminated surgical field. The patients were restarted on Liposomal
Amphotericin B, irrespective of the previous cumulative dosing.
High-risk patients were started on a prophylactic dose of low molecular
weight heparin from the 1st postoperative day to
reduce the incidence of thromboembolism6,7. The
patients were started on isotonic saline nasal douching to clear the
slough and debris upon nasal pack removal. Early recovery after surgery
(ERAS) guidelines were strictly followed. All patients received
pulmonary conditioning exercises, incentive spirometry, and chest
physiotherapy. The patients were considered for discharge if they were
clinically stable with reasonable control of comorbidities, completed
their target dosage of amphotericin B and had no radiological evidence
of disease.