Rhinocerebral Mucormycosis with Peripheral Facial Palsy; A Case Report

A 60-year-old man with diabetes mellitus visited our clinic with complaints of lowgrade fever, headache, left cheek pain and left periorbital edema on September 13, 1988. Left paranasal sinusitis was found. Left peripheral facial palsy started on September 20. A left probe maxillotomy was performed on September 21. The specimen of maxillary mucosa was consistent with a diagnosis of mucormycosis. Sinusitis was temporarily improved by surgery and local irrigation with amphotericin B, but facial palsy persisted. Left mastoiditis was disclosed by high resolution CT on November 18. He received left frontal, ethmoidal and maxillary sinus debridement and left mastoidectomy on December 7. The vertical segment of the facial nerve was necrotic due to severe inflammation and was resected during the mastoidectomy. Hyphae of mucor were not found in the specimens of mastoid mucosa and facial nerve, but the severity of the inflammation seen in the operative and histological findings suggested that the mastoiditis and the facial neuritis might have been caused by mucormycosis. After the surgical debridement, left sinusitis and mastoiditis were controlled with 6 months of intravenous amphotericin B therapy combined with flucytosine. The authors discuss the management of peripheral facial palsy and em-phasize the importance of combined surgical treatment and antifungal chemotherapy.