Subjects and methods

This is a prospective, single-centre, interventional study at “Blinded for review”. This cross-sectional study has included the patients presenting with recurrence in the frontal bone following the initial treatment of covid associated mucormycosis by surgical debridement and systemic amphotericin B . ten patients admitted and treated at our centre from 1st July 2021 to 30th September 2021 were included in the data analysis. A detailed proforma to record the demographic data, clinical presentation, investigations, points in pathogenesis, and pathogenesis of the management in each patient. The data analysis was performed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. The Institutional Research Cell approval was obtained for the study under reference OW/RC/AIIMS-RPR/2021/571. STROBE guidelines has been utilized for data reporting.
A check nasal endoscopy was done to look for other focus of infection in the sinonasal cavity. A complimentary cross sectional radiological imaging was performed to look for the disease extent and to determine the intracranial spread. The patients were planned for appropriate open surgical debridement based on the disease extent. An intraoperative fungal KOH smear was performed to determine the mucormycosis. After the ablative surgery, a definitive permanent plastic reconstruction procedure was deferred due to the possibility of disease recurrence and contaminated surgical field. The patients were restarted on Liposomal Amphotericin B, irrespective of the previous cumulative dosing. High-risk patients were started on a prophylactic dose of low molecular weight heparin from the 1st postoperative day to reduce the incidence of thromboembolism6,7. The patients were started on isotonic saline nasal douching to clear the slough and debris upon nasal pack removal. Early recovery after surgery (ERAS) guidelines were strictly followed. All patients received pulmonary conditioning exercises, incentive spirometry, and chest physiotherapy. The patients were considered for discharge if they were clinically stable with reasonable control of comorbidities, completed their target dosage of amphotericin B and had no radiological evidence of disease.