A New Diagnostic Criteria and Grading System of Rhino-Maxillary Mucormycosis based on Cone Beam Computed Tomographic Findings

Abstract

Background: Mucormycosis is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. It is the need of the hour to diagnose and treat the increasing cases urgently.

Aim: The aim of this article is to study the common radiographic features of rhinomaxillary mucormycosis (RMM), find diagnostic criteria, and grade the disease according to the radiographic features.

Settings: This study was conducted at Face Three-Dimensional Cone-Beam Computed Tomography (CBCT) Center, Aurangabad, Maharashtra.

Materials and methods: CBCT scans of 30 patients who were referred for CBCT scanning of suspected RMM were retrospectively evaluated for relevant radiological data.

Results: The most common CBCT features of RMM were osteolytic lesions in alveolar bone, palate, nose and nasal cavity, and zygoma along with involvement of paranasal sinuses. About 76.66% of patients had a history of COVID-19 infection.

Conclusion: According to the collected data, the scans of probable rhinomaxillary mucormycosis were graded in three groups - mild, moderate, and severe. The goal of this article is to emphasize the most overlook diagnostic entity - CBCT and its significant importance in early diagnosis, treatment, and prognosis of RMM. Early diagnosis of RMM can save the patients from the extent of morbidity and mortality.

Keywords: Cone-beam computed tomography; grade assessment; mucormycosis; osteolytic lesions; radiology.

Figure 1

Mild: (a) Coronal section showing sinusitis of right maxillary sinus and normal ethmoid sinus. (b) Sagittal section showing no involvement of frontal and sphenoidal sinuses (c) Axial section showing sinusitis of right maxillary sinus. (d) Three-dimensional reconstruction showing normal surface appearance of maxilla

Figure 2

Moderate: (a) Coronal section showing maxilla with osteolytic lesion of alveolar bone with moth eaten, loss of cortication, and breach in lateral wall of maxillary sinus and palate. (b) Sagittal section showing no involvement of sphenoidal sinuses. (c) Axial section showing sinusitis of right ethmoid sinus. (d) Three-dimensional 3D reconstruction showing surface resorption of right maxilla

Figure 3

Severe: (a) Coronal section showing complete osteolysis of right side of maxilla with palate, walls of maxillary sinus, and turbinates. (b) Sagittal section showing involvement of frontal and sphenoidal sinuses (c) Axial section showing sinusitis of right ethmoid sinus along with osteolysis of turbinates. (d) Three-dimensional reconstruction showing osteolysis of right maxilla