A Study on Radiological Imaging in Correlation with Intraoperative Findings in Mucormycosis

Immunocompromised patients and particularly who have acquired COVID 19 infection showing red alert symptoms and signs of sinusitis must be subjected to radiographic evaluation to rule out mucormycosis. ● With CT and MRI we could trace the route of spread of the disease from the pterygopalatine fossa to the orbit via the inferior orbital fissure, to infratemporal fossa via the pterygomaxillary fissure and to the intracranial structures via the pterygoid canal, foramen rotundum or via the orbits and surgery can be planned accordingly. ● The fungi most commonly disseminates via perivascular channels and therefore can extend through bony partitions without radiological evidence of bone destruction. It is a good practice to remove the posterior wall of maxilla to expose the pterygopalatine fossa involvement is evident on MRI. ● Skull base osteomyelitis and bony involvement is usually absent despite deep extension of the disease. This has been attributed to the angioinvasiveness of the fungi. Marrow edema is the earliest feature of osteomyelitis which could be missed on CT and can be picked up well early by MRI. ● Oral cavity involvement is manifested as discoloration of the palate, necrosis and erosion suggesting vascular impediment. ● The intracranial extension of the disease most likely occurs via direct perivascular and perineural channels through the cribriform plate into the frontal lobe causing necrosis and abscess formation. ● Disparity between imaging studies and intraoperative findings is because the radiological imaging may take time to reflect the actual happening in the natural course of the disease which is rapid. The interval between imaging to monitor the extent of the disease and surgical management should be short. ● This study entailed a coarse correction for the treatment modality by the combination of information from clinical examination, imaging studies and intraoperative findings which provides the most accurate staging of the disease