Sweed Ahmed Hassan, Anany Ahmed Mohammad, Hussein Atef, Nada Waleed, Eesa Mohamed, Elnashar Ismail, Mobashir Mohamed, Ibrahim Enas Moustafa, Elmaghawry Mohammed Elsayed
Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt.
Department of Ophthalmology, Faculty of Medicine, Zagazig University, Egypt.
Int Arch Otorhinolaryngol. 2025 Jan 23;29(1):1-7. doi: 10.1055/s-0044-1791645. eCollection 2025 Jan.
Mucormycosis is an aggressive, lethal fungal infection affecting the nasal and paranasal territory in immunocompromised patients. Orbital involvement is not uncommon and may require orbital exenteration. The management of orbital involvement in invasive fungal sinusitis is challenging, ranging from conservative retrobulbar amphotericin B injection in the early stages to orbital exenteration in late stages. Endoscopic endonasal debridement is a minimally invasive technique used to manage orbital fungal involvement in the late stages. Endoscopic endonasal orbital clearance was performed to manage late-stage orbital invasive fungal infection (≥ stage 3c) or after failure of retrobulbar amphotericin B injection with no light perception. Removal of the lamina papyracea (LP) and incision of the periorbita were done to expose all the necrotic intraorbital content in the extra and intraconal spaces. A microdebrider was utilized to debride necrotic fungal infected tissue until a healthy vascularized plane was reached. Gelfoam (Pfizer Inc., New York, NY, United States) soaked in amphotericin B was applied as an adjunctive step to deliver antifungal medication to the orbital content. Fourteen patients were included in the study, 9 of whom were male and 5 female, with a mean age of 58.5 years. Eleven patients showed no evidence of disease progression (complete recovery and cessation of medical treatment). Two patients died 15 days after the surgery. The last patient developed frontal lobe abscess but has been treated with double antifungal medication. Endoscopic endonasal orbital debridement could be an effective method to treat late-stage orbital fungal infection without jeopardizing the patient's life. : 4.
毛霉病是一种侵袭性、致死性真菌感染，影响免疫功能低下患者的鼻腔和鼻窦区域。眼眶受累并不罕见，可能需要进行眼眶内容剜除术。 侵袭性真菌性鼻窦炎眼眶受累的治疗具有挑战性，从早期的保守性球后两性霉素B注射到晚期的眼眶内容剜除术。鼻内镜下鼻腔清创术是一种微创手术技术，用于处理晚期眼眶真菌受累情况。 进行鼻内镜下鼻腔眼眶清理术以处理晚期眼眶侵袭性真菌感染（≥3c期）或球后注射两性霉素B失败且无光感的情况。去除纸样板（LP）并切开眶骨膜，以暴露眶内和眶锥内外所有坏死的眶内组织。使用微型清创器清除坏死的真菌感染组织，直至达到健康的血管化平面。将浸泡有两性霉素B的明胶海绵（辉瑞公司，纽约，美国）作为辅助步骤应用，以便将抗真菌药物输送到眶内组织。 该研究纳入了14例患者，其中9例为男性，5例为女性，平均年龄58.5岁。11例患者未出现疾病进展迹象（完全康复并停止药物治疗）。2例患者在手术后15天死亡。最后1例患者出现额叶脓肿，但已接受双重抗真菌药物治疗。 鼻内镜下鼻腔眼眶清创术可能是一种治疗晚期眼眶真菌感染且不危及患者生命的有效方法。 ：4。
