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经功能性鼻内镜鼻窦手术治疗的新冠后鼻上颌毛霉菌病疾病进展的开放手术结果及上颌窦疾病和骨髓炎的拟评估量表

Outcome of Open Surgery in Disease Progression of Post-COVID Rhinomaxillary Mucormycosis Treated by Functional Endoscopic Sinus Surgery and Proposed Evaluation Scale for Maxillary Sinus Disease and Osteomyelitis.

作者信息

Manekar Varsha Sunil, Datarkar Abhay N, Karemore Shramapurna, Ghormode Ashlesha, Deshpande Archana, Walke Damyanti

机构信息

Oral & Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India.

出版信息

J Maxillofac Oral Surg. 2023 Jun;22(2):464-469. doi: 10.1007/s12663-022-01803-5. Epub 2022 Oct 6.

Abstract

INTRODUCTION

Rhinomaxillary Mucormycosis (RMM) is a condition peculiarly seen as post-COVID-19 opportunistic infections with Maxillary Sinus Disease and Osteomyelitis (MSDO). The open method of debridement and closed method are two types of surgical modalities available. There is no scoring method for this infection in maxilla. This paper aims to study the clinical and CT-based outcome of open versus closed surgery of MSDO in post-COVID-19 RMM and propose a new scoring method to evaluate the disease severity, progression as well as recovery.

MATERIAL AND METHODS

Symptomatic cases of RMM ( = 17) with a history of closed surgical treatment were enrolled for this prospective clinical study. These cases were then treated by medicinal and open surgical method. The clinical and CT scan outcomes were compared by proposed new scoring method.The CT-based score for Maxillary Sinus Disease (MSD) and Maxillary Osteomyelitis (MO) from pre-FESS (CT1), Post-FESS (Preoperative, CT2), and Post-operative (CT3) were compared for both right and left sides. One-way ANOVA test and post HOC tests were used for statistical evaluation.

CONCLUSION

The open method of maxillary sinus surgery has given significant improvement in the treatment of RMM already treated by a closed endoscopic approach.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12663-022-01803-5.

摘要

引言

鼻上颌毛霉菌病(RMM)是一种特别常见于新冠病毒感染后上颌窦疾病和骨髓炎(MSDO)的机会性感染。清创的开放方法和闭合方法是两种可用的手术方式。目前尚无针对上颌骨这种感染的评分方法。本文旨在研究新冠病毒感染后RMM中MSDO开放手术与闭合手术的临床及基于CT的结果,并提出一种新的评分方法来评估疾病的严重程度、进展及恢复情况。

材料与方法

本前瞻性临床研究纳入了17例有闭合手术治疗史的有症状RMM病例。这些病例随后接受药物及开放手术治疗。通过提出的新评分方法比较临床和CT扫描结果。比较双侧术前(CT1)、鼻内镜鼻窦手术(FESS)术后(术前,CT2)及术后(CT3)上颌窦疾病(MSD)和上颌骨骨髓炎(MO)基于CT的评分。采用单因素方差分析和事后检验进行统计学评估。

结论

上颌窦手术的开放方法在治疗已采用闭合内镜方法治疗的RMM方面取得了显著改善。

补充信息

在线版本包含可在10.1007/s12663-022-01803-5获取的补充材料。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/264a/10130276/041aba03c7dc/12663_2022_1803_Fig1_HTML.jpg

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