Crossed Nerve Palsies in Sinonasal Mucormycosis: A Diabetic’sFacial-Hypoglossal Puzzle

Abstract

Introduction: Sinonasal mucormycosis is an acute invasive fungal infection of the nose and paranasal sinuses, which is rare, opportunistic and potentially fatal, occurring in both normal and immunocompromised individuals. Uncontrolled diabetics and immunocompromised patients are more prone to this invasive fungal infection. Sinonasal mucormycosis is approximately 1.7 cases per 1,000,000 inhabitants per year. Incidence of VII Cranial nerve palsy is 11% in these cases, and coexistence of ipsilateral Facial nerve and contralateral hypoglossal nerve is not documented in existing literature.

Case Report: A 53-year-old woman was diagnosed with Sinonasal Mucormycosis with extension to the skull base and Infratemporal fossa with involvement of ipsilateral facial nerve palsy and contralateral hypoglossal nerve palsy, in the setting of newly diagnosed and uncontrolled diabetes mellitus. She was promptly started on Liposomal Amphotericin-B and underwent “Endoscopic trans-nasal trans-maxillary trans-pterygoid debridement”.

Conclusion: Mucormycosis is a rare condition that is still fatal in the era of medical and surgical advancements. A combination of endoscopic surgical
debridement followed by intravenous Amphotericin B therapy is quintessential in the management of such patients and has less morbidity compared with conventional treatment. Rare presentations like multiple cranial nerve palsy, which would otherwise raise the suspicion onwards granulomatous disease, need to be scrutinised and aspects ruled out in effective treatment of patients.