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Case Reports: Rare disease
Batwing incision for a case of bilateral fungal zygomatic osteomyelitis
  1. Sanjeev Yadav,
  2. Ashish Saini,
  3. Abhimanyu Singh and
  4. Hitesh Verma
  1. ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Hitesh Verma; drhitesh10{at}gmail.com

Abstract

Zygomatic osteomyelitis is a rare occurrence due to rich collateral blood supply of bone. A man in his 30s presented with complaints of pain over bilateral cheek and pus discharge below the eye on lateral aspect. He was a known case of COVID-19 associated mucormycosis postendoscopic debridement of sinuses 3 months back. Radiology revealed bilateral destruction of zygoma with discharging sinus. Microbiological analysis confirmed aseptate hyphae in pus, and a diagnosis of bilateral fungal zygomatic osteomyelitis made. Under general anaesthesia, sequestrectomy done using bilateral lateral rhinotomy with extended Dieffenbach’s approach (batwing incision). Postsurgery 3000 mg of liposomal amphotericin was administered. There was no enophthalmos or restricted eye movements postoperatively. Follow-up MRI suggested minimal inflammatory enhancement in maxillary sinus. Patient was discharged on oral antifungals.

  • COVID-19
  • Ear, nose and throat/otolaryngology
  • Surgery

https://doi.org/10.1136/bcr-2021-247387

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    Footnotes

    • Contributors SY is the assisting surgeon, has drafted the case report and followed up the case in ward. Line diagram is made by SY. HV is the corresponding author and primary surgeon in the treatment of the patient. AshS and AbhS helped in the review of literature, taking pictures of patient, taking consent and postoperative follow-up.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.