Abstract
Introduction - The second wave of COVID 19 lead to resurgence of
opportunistic infections due to injudicious use of steroids. Sinonasal
Mucormycosis was declared as an epidemic during the pandemic. The
mucormycosis was managed effectively by surgical debridement along with
systemic amphotericin B. Now, following the initial treatment of
mucormycosis there is a resurgence, in the form of fungal osteomyelitis
of the frontal bone. Methods – the prospective study included the cases
from ten patients with fungal osteomyelitis of frontal bone due to
mucormycosis, all the patients underwent surgical debridement of
sequestrum and involucrum with systemic antifungals. Results - The
average duration of the recurrence was 22 days following the initial
treatment Range (10 days to 33 days). Extracranial bossing following
outer frontal cortex erosion in 30% of cases, bicortical erosion in
30%, bifrontal involvement (20%), dural involvement (30%), brain
parenchymal involvement and prefrontal cortex (20%) case. All cases
underwent debridement of entire sequestrous bone and involucrum till
normal bone was identified. The mean duration of admission was 4 weeks
(3 to 6 weeks). All treated patients are currently alive without
disease, confirmed by CECT. Conclusion - The successful treatment of
fungal osteomyelitis due to mucormycosis requires four pronged approach
(1) early detection (2) multidisciplinary management of comorbidities
(3) surgical debridement of necrotic bone and (4) adequate systemic
antifungal therapy. Long term outcomes of fungal osteomyelitis of
frontal bone are yet to be established