Endoscopic assessment of sinonasal mucormycosis with SPIES: The ‘battlefield’ sign

Abstract

Sinonasal mucormycosis is an extremely challenging pathology for the ear, nose and throat (ENT) surgeon from a therapeutic point of view. The disease affects immunocompromised patients and exhibits lethal potential. Although the diagnosis is relatively easy to suspect due to the distinctive clinical aspects which consists of black crusting present in the nasal fossae able to be confirmed by biopsy, the treatment requires resection of all affected tissue with safety limits. Due to the tendency of invasion associated with this fungal infection and taking into account the location involved (the sinonasal area) and the grave condition of these patients, it is extremely important to perform only the minimal resection necessary, but that includes all tissue infected by the fungus. This article presents a minimally invasive method of evaluation that can be performed during endoscopic surgical intervention and that aids the surgeon to better evaluate the affected area. It is associated with no additional risks for the patients, but it helps the surgeon to perform the intervention efficiently while not damaging healthy tissue. The authors consider that the method presented will aid the surgeon during the endoscopic surgical intervention in evaluating the lesion and resecting all the affected tissue while preserving healthy areas.