Pterygopalatine fossa, a hive for fungus in rhino orbital mucormycosis: a case series

The study aims to evaluate the involvement of pterygopalatine fossa (PPF) in rhino orbital mucormycosis and to study various outcomes that occurred as a result of the interventions. We conducted a retrospective; observational study performed using KOH mounts, histopathology, computed tomography paranasal sinuses (CT PNS) scans from June 1 to July 31 in 2021 at Alluri Sitarama Raju academy of medical sciences and hospital, Eluru. A total of 39 cases were admitted during that period. Patients were administered with liposomal amphotericin-B injection, and surgical debridement of local tissues was performed via endoscopic sinus surgery (ESS), modified endoscopic Denker's approach, orbitotomy and maxillectomy. Out of 39 patients, 29 (74.3%) patients had the involvement of PPF using CT PNS. Most of the patients were male (71.8%). The 10% potassium hydroxide (KOH) mounts were found positive in 71.8%. The 94.8% of patients had a history of COVID-19 infection. ESS via modified Denker’s approach was performed in 53.8%. Our findings show that PPF involvement is the main conduit for the aggressive spread of the rhino orbital mucormycosis disease. Therefore, further treatment with medical and surgical techniques could effectively halt the fatal outcomes of the disease at the earliest stages.