Last trip, I saw a young girl with maxillary swelling and foul breath. She had a CT that showed sinusitis. We performed a caldwell-Luc procedure and she improved. Interestingly, the wall of her maxillary sinus was already destroyed. She returned to the hospital 2 days ago with dramatic facial and periorbital swelling. She also has an area of necrosis on the nose.
I think this poor girl has rhinocerebral mucormycosis. This is a terrible disease with a 50% mortality. I had a teleconference with Dr. Kelechi, a doctor at NCH, and the girl's family today via gmail. We have decided to explore her nose and sinus.Dr. Kelechi will do the surgery even though he is not a surgeon. He is a brave man!
ADDENDUM: The surgery went well and the patient is stable so far. A significant amount of necrotic tissue was debrided, especially from the right nasal passageways.