Recurrent Rhinosporidiosis: Coblation Assisted Surgical Resection—A Novel Approach in Management

Abstract

Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning.

Rhinosporidiosis- A retrospection

“…8,3 Natural habitat of R.seeberi is stagnant water like ponds, back waters and reservoirs and hence the river sand workers and people indulged in agricultural work who bathed in ponds where animals also bathed combined with digital microtrauma are at risk of developing rhinosporidiosis especially of upper respiratory tract and eye. [9][10][11] All of patients in our study were agriculturists and all had history of bathing in ponds, rivers or reservoirs. Similar findings were observed in Karthikeyan P, Bhandary S and Chakraborty D in their studies.…”

“…Laser excision and use of harmonic scalpel has been tried owing to its superior haemostasis and capability of preserving the local integrity of the tissue. 10,15 Coblation, radiofrequency cautery, has been reported to penetrate surrounding tissues to a depth of only 100µm. As the temperature does not exceed 60⁰C in coblation mode, there is less lateral thermal damage as seen with cautery and laser.…”

“…Dissemination (also known as malignant rhinosporidiosis) to the limbs, trunk and viscera has been described with a rare fatality when the brain was involved. 6,10 In the nasal rhinosporidiosis, patients usually present with nasal obstruction and epistaxis. On examination, typical lesions are polypoidal, granular and red in colour due to the vascularity.…”

Rhinosporidiosis: the largest case series in Brazil

“…The ablation technique (cold ablation) may be a promising new tool in the surgical resection of recurrent rhinosporidiosis. This technique reduces the chance of contamination of the surrounding areas and prevents autoinoculation (24) . Recently, the antibiotic, dapsone, has shown positive results that complement the treatment, preventing relapses in several infection sites and in cases of inadequate surgical resection (25) (26) (27) .…”

Human rhinosporidiosis: still an elusive disease

“…This technique helps to reduce the chance of contamination of the surrounding tissues and prevents the auto-inoculations. 36 Laser is also useful tool for adequate cauterization along with good hemostasis so reduce chance of complications and recurrence. 37 CO2 laser is helpful for lesions over nasal septum up to the choana and roof of the nasopharynx and it minimizes the chance of recurrence.…”