Aishwarya, P (2022) Role of Endoscopic Trans Nasal Orbital Fat Sampling in Rhino Orbital Mucormycosis Post Covid-19 Pandemic. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Coronavirus disease (COVID – 19) due to coronavirus 2 (SARS-CoV-2) caused worst pandemic the world has ever witnessed [1-3]. It is an ongoing pandemic with new variants of the virus causing new waves of disease. With increasing number of cases, a number of secondary complications were defined following COVID 19 infection including fungal infection. AIMS AND OBJECTIVE OF THE STUDY: 1. To study the role of endoscopic trans nasal orbital fat sampling in the management of rhino orbital Mucor mycosis. 2. To study the correlation between clinical, radiological, intra operative and histopathological findings of orbital involvement. 3. To find out the orbital involvement in cases with intact bony boundaries. MATERIAL AND METHODS: STUDY DESIGN: Cross-sectional study. SOURCE: Case records of patients with rhino orbital mucormycosis undergoing endoscopic sinus surgery with medial orbitotomy and orbital fat sampling in the Department of UIORL, RGGGH & Madras Medical College, Chennai from May 2021 to December 2021 obtained from the medical records department. SAMPLE SIZE: 75. INCLUSION CRITERIA: 1. All patients who undergo endoscopic medical orbitotomy with any one of the following A. Clinical symptoms: ● Lid edema, ● Peri orbital swelling, ● Ptosis, ● Chemosis, ● Proptosis, ● Visual disturbances. B. Radiological evidence of a. Involvement of extra conal / intra conal spaces. b. pre-septal soft tissues involvement. c. Orbital apex/ superior oblique fissure involvement. d. Peri Optic neural fat thickening. EXCLUSION CRITERIA: 1. Nasal histopathology negative for invasive fungal sinusitis. 2. Poor general condition. 3. Patients without orbital or radiological findings of orbital involvement. CONCLUSION: ❖ CT has a sensitivity of 74% and a specificity of 77% and not able to detect only about 23% of orbital involvement. Thus CT detection of involvement draws immediate attention. The cases missed by CT can be picked up by MRI which showed Extraconal fat stranding in all patients with orbital involvement. Thus although CT is a sensitive and specific modality, MRI may be required to avoid missing an orbital involvement. ❖ Intraoperatively observed healthy fat is rarely positive for Mucormycosis. ❖ Presence of earliest possible diagnostic evidence of the disease with KOH positivity warrants biopsy, thorough radiological evaluation and presence of even extraconal or intraconal fat stranding requires immediate aggressive management to prevent irreversible loss of vision as spread has already occurred concomitantly via the blood vessels to several vital structures contained in the spaces of the orbit and bony erosion is a relatively late finding. ❖ In the patients with orbital involvement the role of retrobulbar amphotericin in containing the disease cannot be ruled out. RBA did not produce vision loss as per our study and therefore employing it at first evidence of early involvement of the orbit can prevent the eye from severe complications. ❖ When medial orbital spread has occurred via the lamina papyracea lid edema was the most common symptom of preseptal cellulitis whereas a direct tissue spread to orbital apex via the inferior oblique fissure results in vision loss and total ophthalmoplegia. ❖ Medial orbitotomy and decompression was done in all patients of our study sample shows improvement in outcomes in case of extraocular movement, ptosis, proptosis and chemosis but vision loss has not improved in any of the cases. ❖ Performing a medial orbitotomy, and clearance of pterygopalatine fossa, along with prompt clearance of disease in the paranasal sinuses may play a vital role in containing the disease along with medical management with Amphotericin B.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221914004 |
| Uncontrolled Keywords: | Endoscopic Trans Nasal Orbital Fat Sampling, Rhino Orbital Mucormycosis, Post Covid-19 Pandemic. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 18 Apr 2022 10:05 |
| Last Modified: | 17 Dec 2023 03:25 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19349 |
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