Avoiding repeated surgery in patients with acute invasive fungal sinusitis.

There were 42 male and 9 female patients aged 9-68 years (mean: 42.5 years). Forty (78.4%) patients were diabetic and 17.6% had hematological malignancies. The majority (60.8%) had stage 2 or 3 disease. Partial/total maxillectomy (29.4%), orbital exenteration (7.8%) and craniotomy (2%) were also performed at a single session in 20 patients. Intra-operative sampling of all sinuses was performed. Six patients who appeared to have unilateral disease based on clinicoradiological assessment were found to have bilateral disease. Only 2 patients required revision surgery. Follow-up ranged from 3 to 24 months. The survival rate was 68.2% overall and 73.5% for diabetics alone. The difference in outcomes with a single surgery versus multiple surgeries was not significant (p = 0.09) CONCLUSION: A surgical protocol involving bilateral FESS along with debridement of visibly affected areas and antifungal therapy avoids repeated surgery in patients with AIFS with no change in outcomes. The absence of clinicoradiological involvement of the paranasal sinuses does not preclude the presence of invasive fungal disease in these sinuses.