Acute Invasive Fungal Rhinosinusitis: Presentation of 19 cases, review of the literature and a new classification system

Publication date: Available online 15 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Onur Ergun, Emel Tahir, Consultant Oguz Kuscu, Burce Ozgen, Taner Yilmaz
PurposeThe aim of this study is to determine the correlation between AIFRS and underlying diseases, microorganisms, presenting symptoms, extent of disease, radiological findings, and outcomes and propose a new classification system.Material and methodsThe data of 19 AIFRS cases were analyzed retrospectively. MRI and CT were performed in all patients preoperatively. All patients underwent at least one surgical debridement.ResultsHematologic diseases were the most common(52%) underlying disease. Patients with type-2 diabetes and those with multiple etiologies causing immunosuppression had the lowest survival. Both Aspergillus spp. and Mucoraceae spp. were isolated in 9 patients, but were not associated with poor prognosis. Headache and nasal discharge/crusting were the most common presenting symptoms. Premaxillary involvement was significantly correlated with poor prognosis(p=0.001). Unilateral involvement was correlated with poor prognosis although this finding was not significant(p=0.111). The overall mortality rate was 61.2%. Patients with neutropenia that was corrected had 80% survival(p=0.014). Cessation of corticosteroids and regulating the blood glucose level in patients with immunosuppression due to corticosteroid use resulted in 75% survival.ConclusionThere is not a single curative treatment for acute invasive fungal rhinosinusitis (AIFRS). For a favorable prognosis, underlying conditions must be treated in addition to surgical debridement and antifungals.



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