The Effect of Orbital Exenteration on the Management of Rhino-Orbito-Cerebral Mucormycosis

Abstract

Abstract Background Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening acute angio- invasive fungal infection caused by Mucoraceae family. in immunocompromised individuals. Fungal inoculation starts in the nose and paranasal sinuses and then infiltration of the surrounding bone and soft tissues when it reaches the orbit or the brain, fatal complications may follow. The management of ROCM needs a multi disciplinary approach containing sino-nasal and orbital endoscopic debridement along with systemic antifungal drugs. when the orbit is severely affected, immediate orbital exenteration is a must to enhance the patient’s survival and limit the spread of the disease. Aim of the Study The aim of this systematic review is to identify the effect of orbital exenteration in the management of orbital invasion in ROCM patients on the improvement of patient survival and prognosis. Patients and Methods Studies included are Retrospective observational and prospective studies conducted in the last 20 years Participants included: Patients with ROCM fulfilling the clinical, radiological and pathological/microbiological criteria for diagnosis with ROCM Results Orbital exentration halts ROCM progression and overall Survival rates of orbital exentration have been improved in last 20 years becoming as high as 82.6 % in our study. Survival rates of orbital exenteration in ROCM patients after Covid 19 were 84.5% compared to 60.6% before covid 19. Also the recovery time reduced to 36.6 days in this metalysis with a promising results in reconstructive surgeries for cosmetic and psychological efforts. Conclusion Orbital exentration together with medical treatment and sinus debridement control ROCM progression. Patients’ survival and recovery time have been enhanced using this aggressive procedure. No guidelines is found concerning when the exenteraton should be done