Reconstructive cranial surgery for invasive and non-responsive mucormycosis

BMJ Case Rep. 2023 Sep 15;16(9):e253808. doi: 10.1136/bcr-2022-253808.

Abstract

The incidence of mucormycosis showed a sharp rise during the COVID-19 pandemic in vulnerable populations like people with diabetes. Here, we report a case of mucormycosis of the frontal and ethmoid sinuses in a man in his mid-50s with a background of diabetes mellitus and COVID-19 infection requiring steroids and oxygen support. The infection had remained persistent despite initial debridement by functional endoscopic sinus surgery of the anterior frontal sinus wall and re-exploration, followed by debridement using the brow incision. The patient had received an entire course of systemic antifungal therapy during the postoperative period. A bifrontal craniotomy, excision of the supraorbital ridge and complete removal of bilateral frontal sinuses managed the persistent fungal infection. The defect was reconstructed with a custom-made three-dimensional-printed MRI-compatible titanium cranioplasty mesh. The patient had no signs of infection on the 9-month follow-up.

Keywords: COVID-19; Diabetes; Otolaryngology / ENT.

Publication types

  • Case Reports

MeSH terms

  • COVID-19*
  • Humans
  • Male
  • Mucormycosis* / surgery
  • Pandemics
  • Plastic Surgery Procedures*
  • Skull