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Rhino-orbito-cerebral mucormycoses constitute a severe fungal infection. These infections mostly arise in immunosuppressed patients. The surgery aiming at resecting necrosed hurts showed its interest in term of survival for lung and cutaneous mucormycosis. However, treatment of rhino-orbito-cerebral location of mucormycosis is not well defined. Transnasal endoscopic surgery allows local control of the disease, better post-operative outcomes than transfacial approaches and less sequelae. However, transfacial approaches are sometimes necessary to allow cutaneous resection or exenteration, the indications of which still remain controversial. The retrospective study of 22 patients with mucormycosis allowed to show that radical surgical treatment allowed local control of the disease with an improved survival. Further prospective studies (PHRC MICCA, current) are required to standardize the management of this rare but potentially lethal pathology., (© 2013 médecine/sciences – Inserm / SRMS.)

Cervical fasciitis is one of the most severe ENT emergencies, requiring immediate management by a multidisciplinary team. Often due to a benign pharyngeal or dental infection, this life-threatening condition leads to extensive necrosis spreading along the fascia of the neck, possibly to the mediastinum. A retrospective analysis of 150 consecutive patients admitted to our institution between January 2001 and December 2006 showed:--a 7% mortality rate;--pulmonary involvement in one-third of cases and hemodynamic failure or mediastinitis in half the patients;--mechanical ventilation for an average of 10 days, intubation for 13 days, tracheostomy for 31 days, intensive care unit management for 17 days, and hospitalization for 26 days; and--functional and esthetic sequelae in about half the patients. These data underscore the extreme severity of cervicofacial fasciitis and the need to pay close attention to any general or functional signs of severe sepsis in patients with apparently mild head or neck infections. Such patients should be urgently referred to a tertiary center for immediate CT scan and surgical drainage of any cervical or thoracic abscesses. Intensive medical care is needed to manage the frequent cardio-hemodynamic failure and secondary pulmonary/mediastinal infections. The only possible predisposing factors so far identified are inadequate initial medical treatment and self-medication with nonsteroidal antiinflammatory drugs.