Facial Translocation Approach for Management of Invasive Sinonasal Aspergillosis

Invasive Aspergillus flavus sinusitis in an immunocompetent patient using intranasal cocaine

“…Mortality rates are high, ranging from 28% to 80%, and is particularly high after the onset of neurological symptoms [1] , [5] , [10] , [16] , [20] . Although Aspergillus fumigatus is the most common species to cause invasive aspergillosis (80–90%), A. flavus is less common (5–10%) but more destructive due to toxin production [2] , [3] , [4] , [11] .…”

“…Invasive fungal sinusitis generally occurs in the setting of neutropenia, immunosuppressive drugs, diabetes, HIV, trauma, or radiation therapy [2] , [3] , [4] , [5] . Other associated factors include male gender [3] , [10] , [20] , [21] , asthma [11] , [12] , use of inhalational steroids [1] , [12] , marijuana use [12] , heavy smoking [3] , individuals in the 3rd or 4th decade of life [10] , [21] , alcoholism [13] , [22] , farming occupation [3] , [8] , [11] , [12] , trauma or a surgical procedure such as implantation of prosthetic material [16] , septal surgery [20] , and endemic locations such as the Middle East, Indian sub-continent, and Southern United States [7] , [8] , [9] likely due to hot, dry climates [10] .…”

“…As illustrated here, surgery is of paramount importance for both diagnosis and treatment. Non-invasive disease (allergic aspergillosis or aspergilloma) can convert to semi-invasive (locally destructive disease without tissue invasion), or invasive disease without adequate debridement and antifungal treatment [4] , [9] , [12] , [13] , [28] , [29] . This is illustrated in one case report where non-invasive disease converted to invasive disease in an elderly patient [29] .…”

“…Invasive fungal sinusitis is a dangerous form of infection by Aspergillus , with mortality rates as high as 80% [1] . Although invasive infection typically occurs in immunocompromised patients [2] , [3] , [4] , [5] , [6] , other risk factors include hot, dry climates [7] , [8] , [9] , [10] , farming occupations [3] , [8] , [11] , [12] , maxillary tooth extraction [2] , [11] , [12] , [13] , [14] , and intranasal cocaine use [5] , [15] . Diagnosis can be challenging as topical nasal cultures are often negative and symptoms often precede significant radiological findings [8] , [13] , [16] , [17] .…”