Dhirawani Rajesh, Asrani Sumit, Pathak Sanyog, Sharma Ankit
Department of Oral and Maxillofacial Surgery, Hitkarini Dental College & Hospital, Jabalpur, 482001 Madhya Pradesh India.
J Maxillofac Oral Surg. 2015 Mar;14(Suppl 1):482-7. doi: 10.1007/s12663-014-0691-z. Epub 2014 Sep 30.
Aspergillosis is an uncommon fungal disease seen commonly in paranasal sinuses. It may be of noninvasive variety which is restricted to paranasal sinuses seen in healthy and immunocompetent hosts or may present as invasive form seen in immunocompromised hosts especially in diabetics and patients under long term immunosuppressant therapy. Along with paranasal sinuses invasive forms may encroach upon surrounding adjacent structures involving the orbit and extend intracranially. Orbital and intracranial involvement have a high mortality rate. Early diagnosis of the lesion and prompt aggressive management is important for better prognosis. Aggressive treatment includes surgical debulking and medical management mainly with systemic amphotericin B and other azoles. In orbito-cranial involvement, due to limited access to cranial base, it becomes difficult to surgically debulk the lesion with safety to surrounding important structures. Facial translocation approach gives adequate access to paranasal sinuses, orbit and anterior cranial base. Reported here are two cases of invasive cranio-orbito-nasal aspergillosis treated with facial translocation approach.
曲霉病是一种不常见的真菌病，常见于鼻窦。它可能是非侵袭性的，局限于健康且免疫功能正常宿主的鼻窦，也可能表现为侵袭性形式，见于免疫功能低下的宿主，尤其是糖尿病患者和长期接受免疫抑制治疗的患者。除了鼻窦，侵袭性形式可能侵犯周围相邻结构，累及眼眶并向颅内扩展。眼眶和颅内受累的死亡率很高。早期诊断病变并及时积极治疗对于改善预后很重要。积极治疗包括手术切除和药物治疗，主要使用全身性两性霉素B和其他唑类药物。在眶颅受累时，由于接近颅底的空间有限，难以在确保周围重要结构安全的情况下通过手术切除病变。面部移位手术入路能够充分暴露鼻窦、眼眶和前颅底。本文报告了两例采用面部移位手术入路治疗的侵袭性颅眶鼻曲霉病病例。
