Purpose Cavernous sinus thrombosis (CST) is a complication of rhino-orbital-cerebral mucormycosis. The COVID-19 pandemic saw a rapid surge in the cases of acute fungal sinusitis, many of whom also had CST, further contributing to the ophthalmoplegia. This study was a retrospective audit of patients with mucormycosis treated during the first wave of the COVID-19 pandemic.Methods This study was conducted at a tertiary referral centre, and patients with rhino-orbital mucormycosis were included. Relevant laboratory investigations and CT scans of the paranasal sinuses and the cavernous sinus were analysed. Mortality at discharge was calculated.Results 61 cases of invasive mucormycosis were seen, of whom 20 were COVID-19 positive, and 21 had radiological evidence of CST. All patients in the study initially presented with clinical suspicion of mucormycosis, and COVID-19 was diagnosed during pre-admission investigations. 93% of patients had diabetes. A majority of patients received Amphotericin B and surgical debridement. The sphenoid sinus was involved in 32(52%) patients and the orbit in 34(56%). Factors affecting CST, such as platelet counts, were studied. Fifteen (25%) patients succumbed during their treatment.Conclusions 34.4% of patients with mucormycosis developed CST. Being COVID-19 positive led to an increase in mortality; however, there was no significant increase in death due to simultaneous COVID-19 and CST. Sinus involvement was not significant for the development of CST.
Schwannomas of the eighth nerve are common, usually found in syndromic association with neurofibromatosis-2. The occurrence of seventh nerve schwannoma, especially in its extratemporal course, is very rare. Here, we present a case report of an extratemporal facial nerve schwannoma diagnosed preoperatively with cytopathology and postoperative histopathologic confirmation. Histopathology provides the confirmatory diagnosis in such cases. An atypical diagnosis of neural schwannomas should be kept in mind when facial palsy is clinically encountered in the absence of any other aetiological factors.
Introduction: Kaposiform haemangioendotheliomas (KHE) are extremely rare, borderline malignant, locally aggressive vascular tumours. Although more commonly seen in childhood and adolescents, some very rare reports in adults do exist. KHE is usually found in the retroperitoneum, over the extremities and the soft tissues of the trunk, mediastinum and the head and neck regions. Prior published reports have shown a strong association with the Kasabach-Merritt phenomenon (KMP). We present a very rare case of KHE of the sublingual gland in an adult, which was not associated with KMP and was resected completely without any sequelae. Case report: A 42-year-old female presented with a painful swelling over the floor of the mouth on the right for a year. Clinical examination revealed a bi-digitally palpable, non-transilluminant lesion on the right side of the lingual frenulum. Radiological investigations suggested the possibility of a benign soft tissue tumour arising from the sublingual gland. The patient underwent an intraoral excision of the lesion. The biopsy revealed spindle-shaped tumour cells in fascicles, surrounded by vascular spaces, suggestive of a KHE. The patient was offered radiation therapy, which she declined and continued to be on follow-up for two years. She remains symptom-free to date.Conclusion: Excision of a KHE of the floor of the mouth proved to be sufficient, without the evidence of any residual lesion or progression of symptoms. To the best of our knowledge, our case represents the first reported case in the literature of a KHE arising from the salivary glands in an adult.
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