ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India.
ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India
BMJ Case Rep. 2022 May 31;15(5):e247387. doi: 10.1136/bcr-2021-247387.
Zygomatic osteomyelitis is a rare occurrence due to rich collateral blood supply of bone. A man in his 30s presented with complaints of pain over bilateral cheek and pus discharge below the eye on lateral aspect. He was a known case of COVID-19 associated mucormycosis postendoscopic debridement of sinuses 3 months back. Radiology revealed bilateral destruction of zygoma with discharging sinus. Microbiological analysis confirmed aseptate hyphae in pus, and a diagnosis of bilateral fungal zygomatic osteomyelitis made. Under general anaesthesia, sequestrectomy done using bilateral lateral rhinotomy with extended Dieffenbach's approach (batwing incision). Postsurgery 3000 mg of liposomal amphotericin was administered. There was no enophthalmos or restricted eye movements postoperatively. Follow-up MRI suggested minimal inflammatory enhancement in maxillary sinus. Patient was discharged on oral antifungals.
颧骨骨髓炎由于骨骼丰富的侧支血液供应而较为罕见。一名 30 多岁的男性出现双侧脸颊疼痛和眼外侧脓液排出的症状。他是 3 个月前鼻窦内镜清创术后与 COVID-19 相关的毛霉菌病的已知病例。放射学检查显示双侧颧骨破坏伴窦道排出。微生物分析确认脓液中有不分隔的菌丝，诊断为双侧真菌性颧骨骨髓炎。在全身麻醉下，采用双侧外侧鼻切开术和扩展的 Dieffenbach 入路（蝙蝠翼切口）进行病灶切除术。术后给予 3000mg 的脂质体两性霉素 B。术后无眼球内陷或眼运动受限。随访 MRI 提示上颌窦炎症轻微强化。患者出院后口服抗真菌药物治疗。
