Pune: Careful opening of damaged sinus networks in deeper face areas, pterygopalatine fossa, is the key to preventing the spread of covid mucocorosis to the eyes and brain.
This is one of the important points emphasized by experts with patients who need a large amount of revision operations and some of them (20%) face recurrent days or months after recovery.
A large number of these patients require permissions of repetition surgery even in fields such as frontal sinuses, where recurrence should not occur, indicating incomplete cleaning of damaged tissue during the first operation, experts said.
“His recurrence is rules than the exception in mukormycosis.
At present, the incidence of restored patients who need revision operations are around 20%,” said the Tht Surgeon Samir Joshi, who was the head of the Department and Professor of ENT at Sassoon General Hospital.
The tertiary care reference unit so far treats the highest number of 391 patients with covid-related mucormosis.
Cleaning the entire mushroom in one go (operation) is almost impossible because the fungus in the wider zone between the dead area (damaged sinus network) and the living room (healthy network) is not visible.
“That is why the cleaning of postoperative, care and injection of amphotericin is at least for two weeks very vital to avoid recurrence,” Joshi said.
Usually, areas such as frontal sinuses should not see recurrence.
But some patients come with recurrence in a frontal sinus which is a matter of concern.
“This is because the frontal sinus is dried by gravity while other sinuses such as maxilla do not flow with gravity because of the opening they are at a higher level even after widening the opening for cleaning damaged network surgery,” Joshi said.
The disease recurrence must be, therefore, does not occur if the damaged tissue is cleaned adequately in the first operation, especially in the field of the frontal sinus.
“This is where the role of expertise and experience is very important.
The surgeon can help a senior colleague, if he is not sure of dealing with areas such as the frontal sinus, Pterygopalatine Fossa and other regions in the skull base,” Joshi said.
Many doctors do revised operations in rapid succession without understanding that operation is not the only treatment option.
This can cause the spread of disease rather than detention, if not done for the correct indication.
“Someone must see the amphoteric effect and then make a decision to revise the operation.
I have seen that sometimes even the interpretation of the magnetic resonance imaging (MRI), which is a difficult investigation to interpret, has led to revise the operation,” he said.
Working as a team is very important to avoid recurrence.
ENT, oral, neuro, and eye surgeons, and doctors have a definite role.
“We have done most cases in collaboration with ENT surgeons for necrotic network permits from the frontal sinuses, sphenoids, and ethmoid.
Local Debridement and topical mushroom medicines play a very vital role in prevention of recurrence,” said oral and maxillary surgeon said JB Garde.
Garde has claimed to have managed to take care of 62 patients with zero recurrence so far.
The use of drug therapy, including amphotericin b injection, is also the key to preventing recurrence.
“To prevent recurrence, disease control must be achieved correctly before changing amphotericin B to reduce therapy with oral posaconazol.
Apart from incomplete debridement, the breakthrough mucer can occur if the optimal level of drugs in the blood is not achieved,” said Sanjay Pujari, an expert Infectious diseases and members of the National Covid Task Force.
Posaconazole levels must be achieved in the blood and must be measured 3-5 days after starting treatment, he said.