Orbitomaxillofacial Mucormycosis Requiring Complex Multifactorial Management

Abstract

Mucormycosis is a rare fungal infection caused by ubiquitous fungi in the order Mucorales. It is the most rapidly progressing fulminant fungal infection that mimics necrotizing soft-tissue infections. Overwhelming fungal sepsis develops quickly and mortality rates approach 70%. Culture negative necrotizing infections and cutaneous necrosis following a vascular pattern should raise suspicion for this rare entity. We describe avoiding mortality in a case of orbitomaxillofacial mucormycosis multifactorially treated with: radical serial debridement, topical amphotericin B irrigation and dressings, parenteral amphotericin B, and hyperbaric oxygen therapy. Tissue biopsy was central to confirming the diagnosis and directing multimodal management that ultimately prevented dissemination to the central nervous system and mortality.

Fig. 1.

Axial view of computed tomography images demonstrating initial maxillary sinusitis.

Fig. 2.

Twenty-four hours after initial exploration, demonstrating the area of progressing necrosis

Fig. 3.

Wound following 2 previous debridements with gray, necrotic tissue overlying the parotid and ear demonstrating continued disease progression.

Fig. 4.

Soft-tissue reconstruction, 5 months postoperatively from ALT flap. A small area of forehead wound breakdown required subsequent closure with a pedicled forehead flap, also shown here.