SA2 - Does adjunct hyperbaric oxygen therapy and methylene blue contain further spread of covid associated sinomaxillary mucormycosis? A retrospective study
Abstract: 1.Statement of the problem: The aim of the study was to assess the role of post-debridement HBO therapy along with local application and steam inhalation with methylene blue as an adjunct in the management of COVID associated sino-maxillary mucormycosis cases. 2.Materials and methods: The study was designed as a retrospective observational study of COVID associated sino-maxillary mucormycosis patients. A total of 33 patients operated by single surgeon from the Outpatient Department of Oral and Maxillofacial Surgery at Maulana Azad Institute of Dental Sciences, New Delhi were recruited. The records of all the patients treated for COVID associated sino-maxillary mucormycosis patients between May 2021 to February 2022 were reviewed. The study included only those patients in which records of clinical, radiographic and histologic diagnosis of COVID associated sino-maxillary mucormycosis patients was available and included those patients who had undergone post-surgical hyperbaric oxygen therapy along with local application of methylene blue solution. 3.Methods of data analysis Statistical analysis was performed using SPSS software (IBM Corp, Armonk, NY). Data was presented as mean and appropriate Statistical tests were applied. 4.
Results: At 6 months follow-up, none of the included patients had any residual discomfort, limited facial swelling, and no clinical or radiological indications of recurrence. (Figure 1) 5. Outcomes Data: There were 21 males (63.6%) and 12 females (36. 4.%) with ages ranging from 23 to 68 years (Mean Age: 50.81±7.92). In 42.4 % patients, more than one of ipsilateral sinuses were involved. 3 patients (9%) also had simultaneous involvement of mandible along with sino-maxillary complex. The most commonly involved sinuses were maxillary and ethmoid sinuses together in 19 patients (57.5%), followed by maxillary, ethmoid and sphenoid in combination in 14 patients (42.4 %). Sino-nasal mucosal thickening was the most common finding in almost all the cases (96%). Periantral infiltration was seen in 23 patients (72%), whereas orbital extension of inflammation was seen in 1(3%). Cerebral and vascular complications were noted only in 3 (9%) and 0 patients (0%), respectively. All the patients underwent 24-0 hyperbaric oxygen cycles post-surgical debridement (Mean: 33.18±7.72) and were prescribed Tablet Posaconazole as an antifungal agent( 300mg BD on day 1 & then 300mg/d for 3-4 months). (Table 1)
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Conclusion: The conventional surgical treatment usually leads to cosmetic facial deformity as well as functional disturbances in mastication and speech. Sequential debridement may be needed in these cases which further causes discomfort to patient. Moreover, the drugs that are active may be difficult to use on day-to-day basis due to their intravenous mode of administration, potential side effects, high cost and the possibility of drug resistance. Therefore, it is the need of hour to develop an adjunct to these treatments which can decrease the dependence on available modes of treatment. It can be concluded from the study that HBO therapy along with local application and steam inhalation of methylene blue can be proposed as a supportive treatment in the management of COVID associated sino-maxillary mucormycosis cases along with oral antifungal drugs.
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References: 1. Ferguson BJ, Mitchell TG, Moon R, Camporesi EM, Farmer J. Adjunctive Hyperbaric Oxygen for Treatment of Rhinocerebral Mucormycosis. Clin Infect Dis. 1988 May 1;10(3):551–9. 2. Tragiannidis A, Groll AH. Hyperbaric oxygen therapy and other adjunctive treatments for zygomycosis. Clin Microbiol Infect. 2009; 15:82–6.