Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

Purpose

COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management.

Methods

This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021.

Results

Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05).

Conclusion

: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

Benign fibrous histiocytoma of the maxilla: a case report and review of literature

Benign fibrous histiocytoma (BFH) is a mesenchymal tumor which commonly affects the skin of extremities. Histologically, BFH of soft tissues and bone shows similar features, but BFH of the bone is rare with less than 100 cases reported worldwide and usually it involves tibia, femur, and pelvic bone. As far as the oral cavity is concerned, majority of the BFHs are found in the soft tissues of the buccal mucosa, gingiva, lower and upper lips, soft palate, and floor of the mouth. Occurrence of this tumor in the jaw bones is extremely rare as only one case of the maxilla and six cases of the mandible have been reported so far . Hence, the purpose of this article is to report the second case of BFH of the maxilla in a 23-year-old female patient and to review the literature of this entity affecting the jaws.

Use of miniplates in parasymphysis fractures : a survey conducted among oral and maxillofacial surgeons of India

Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or post-operative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fifty-four per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy's principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.

Platelet-Rich fibrin: A second generation platelet concentrate and a new friend of oral and maxillofacial surgeons

To assess the potential use and benefits of Platelet-Rich Fibrin (PRF) over Platelet-Rich Plasma (PRP), for wound healing post oral and maxillofacial surgeries. This article describes the evolution of this second generation platelet concentrate and its multiple uses in various surgical procedures. Around 5 ml of whole venous blood is collected from the patients in each of the two sterile vacutainer tubes of 6 ml capacity without anticoagulant. The vacutainer tubes are then placed in a centrifugal machine at 3000 revolutions per minute (rpm) for 10 minutes, and the middle fraction containing the fibrin clot is then collected 2 mm below lower dividing line, to obtain the PRF. Cavities filled with PRF post oral and maxillofacial surgical procedures, at the institute, showed faster healing in half the time as compared to physiologic healing. PRF, which belongs to a new second generation of platelet concentrates, with simplified processing, and not requiring biochemical blood handling, has several advantages over traditionally prepared PRP, which has been widely used for accelerating soft tissue and hard tissue healing. However, the preparation being strictly autologous, the amount of PRF obtained is limited.