Post-COVID-19 Rhino-Orbito-Maxillary Mucormycosis Defect: Our Surgical Experience with Single Stage Delayed Reconstruction Using Free Flap

Abstract

Introduction The effect of the second wave of COVID-19 was immense in India, specifically in the form of vicious COVID-19-associated mucormycosis. A higher number of radical debridements are required for disease control in combination with antifungal drugs in cases of COVID-19-associated mucormycosis, which results in complex maxillofacial defects. We aimed to evaluate the clinical outcomes in patients with rhino-orbito-maxillary defects due to COVID-19-associated mucormycosis undergoing a single stage delayed free flap reconstruction. Methodology This prospective, single-center, multisurgeon study was performed on eight patients with COVID-19-associated rhino-orbito-maxillary mucormycosis in the department of burns and plastic surgery. The postoperative clinical outcome was evaluated using the University of Washington Quality of Life Questionnaire for patient's quality of life (QOL), aesthetic numeric analog (ANA) scale for patient's satisfaction for aesthetics, and the functional intraoral Glasgow scale for speech and deglutition at 1 and 3 months. Results The median age of the study patients was 40 years, with 75% of the patients being males. Diabetes mellitus (DM) was present in all the patients. Mucormycosis was diagnosed within the first 3 months of COVID-19 infection. Maxillary defect was present in 62.5% of patients, out of which 50% had bilateral maxillary defects. There was significant improvement in the QOL and the aesthetics of patients from 1 to 3 months (p < 0.001). Speech and deglutition were also improved at 3 months, but the difference was not statistically significant. Conclusion Single stage delayed free flap reconstruction can be advocated in patients with COVID-19-associated rhino-orbito-maxillary mucormycosis defect as there is considerable improvement in patients' QOL, aesthetics, speech, and deglutition over a period of time.