Surgery for Pediatric Invasive Fungal Sinonasal Disease

Abstract

Objective: 1) Evaluate the management and outcomes of immunocompromised children with invasive fungal sinonasal disease who were treated with radical surgery. 2) Compare outcomes of radical surgery with less aggressive surgical debridements described in the literature. Method: From 1994 to 2007, eleven pediatric patients with invasive fungal sinonasal disease, who were treated by the same pediatric otolaryngologist, were retrospectively evaluated. Demographics, oncologic diagnoses, absolute neutrophil counts, symptoms, CT scan findings, biopsy and culture results, surgical procedures, anti-fungal therapies, outcomes, and survival were among the data collected. Results: There were 4 males and 7 females with an average age of 10 years (range, 2-14 years). Ten of the patients had relapsed leukemias. Six patients had acute lymphoblastic leukemia, 5 had acute myeloid leukemia. The average number of severely neutropenic days prior to diagnosis of invasive fungal infection was 18 days (range, 8-41 days). Seven patients had alternaria, 4 had aspergillus. Nine patients underwent an external medial maxillectomy, 5 of which were bilateral, and six underwent septectomy. All eleven patients (100%) were cured of their invasive fungal sinonasal disease and did not relapse. Three patients eventually died from other causes. Conclusion: Invasive fungal sinonasal disease is a life-threatening problem in immunocompromised children, especially with relapsed leukemia. Successful treatment depends on timely and aggressive surgical, anti-fungal, and supportive therapies. This is the largest series of pediatric patients with invasive fungal sinonasal disease who underwent aggressive surgery with the best outcomes to date.