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Invasive sino-orbital aspergillosis: surgical decisions and dilemmas

Published online by Cambridge University Press:  08 March 2006

M. Dhiwakar
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
A. Thakar
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
S. Bahadur
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Invasive aspergillosis, one of the common paranasal sinus fungal infections, often secondarily involves the orbit. We report six such cases with orbital extension, all occurring in apparently immunocompetent hosts, to specifically address the difficult diagnostic and therapeutic issues involved. Limited biopsy procedures were often inconclusive, necessitating wide surgical excision to establish the histopathological diagnosis. Conservative orbital debridement proved adequate for cases with disease limited to the infero-medial compartment of the orbit, but resulted in residual progressive disease in the two of the four cases with retro-orbital and apical extension. Orbital exenteration in this latter group, however, proved successful in controlling disease. The present report emphasizes the importance of near-complete extirpation and adjuvant chemotherapy in ensuring a favourable outcome in invasive Aspergillus infections. Orbital exenteration appears justified for posterior orbital disease, regardless of the functional status of the eye, but is inappropriate for anterior orbital disease.

Type
Research Article
Copyright
© Royal Society of Medicine Press Limited 2003

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