Overcoming Delayed Diagnosis of Chronic Invasive Fungal Sinusitis in the Immunocompetent Patient: A Case Report

Abstract

Study Design: Case report. Objective: To highlight the diagnostic and treatment dilemma associated with chronic invasive fungal sinusitis (CIFS) in the immunocompetent individual. Methods: The patient was initially treated for chronic bacterial sinusitis with antibiotic therapy and multiple surgical debridement with no evidence of fungal organisms. Following the completion of the left partial maxillectomy, mucormycosis was finally identified on histopathology, and the appropriate antimicrobial therapy was initiated. During this time, the patient received an interim maxillary obturator for speech and oral function. Following the resolution of CIFS, a computed tomography (CT) of the face was obtained for computer-aided surgical planning for a vascularized fibula flap reconstruction with endosseous dental implants using patient-specific surgical cutting guides and a reconstruction plate. Results: Optimal esthetic and functional outcomes were achieved following the placement of the definitive dental prosthesis. The patient remained free of disease and without pain 2 years postoperatively. Conclusions: Chronic invasive fungal sinusitis in the immunocompetent patient remains rare; however, delayed diagnosis can lead to inadequate treatment and extensive soft and hard tissue necrosis. Obtaining sufficient tissue sampling is essential for a definitive diagnosis of CIFS. This report demonstrates the challenge in diagnosing CIFS and the importance of the multidisciplinary approach to treat CIFS associated with extensive involvement of the maxilla.