Novel endoscopic endonasal approach for management of facial pain in patients with acute invasive fungal sinusitis

Objective Facial pain is a common but barely studied presentation in patients with acute invasive fungal sinusitis (AIFS). Pathogenesis of the symptom can be a cause of disease spread and morbidity. Methods The study was conducted in a tertiary referral center on cases of AIFS complaining of facial pain. Patients’ demographic data were collected. All cases were subjected to CT and MRI of the nasal and paranasal sinuses (PNS) which showed disease infiltration of the pterygopalatine fossa (PPF) and medial infratemporal fossa (ITF) with fungal material. The patients were managed with a combination protocol starting with medical treatment, including systemic antifungal therapy, and then surgical debridement of the necrotic tissues in the nose and PNS. Endonasal endoscopic clearance of the PPF and ITF was performed by the technique demonstrated. Comparison of the preoperative and postoperative facial pain measured by the visual analogue score (VAS) was statistically performed. Results During the study period, 19 cases with AIFS complaining of facial Pain were included. The mean age was 42.37 ± 10.49 years, with 10 males and 9 females included. Twelve cases received amphotericin B infusion; the remaining 7 cases received voriconazole therapy as they were having chronic kidney disease. Mucormycosis was the causative organism in all cases. Statistically significant improvement of the facial pain measured by VAS was encountered with P < 0.001. Conclusion Endonasal endoscopic debridement of the PPF and medial ITF during surgical debridement for patients with AIFS is a novel approach that helps manage facial pain and limits the spread of disease.