Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 216404, 2 pages doi:10.1155/2011/216404 Case Report Rare Presentation of Rhino-Orbital-Cerebral Zygomycosis: Bilateral Facial Nerve Palsy Alireza Mohebbi,1 Hesam Jahandideh,1 and Ali Amini Harandi2 1 Otolaryngology, Head and Neck Surgery Department and Research Center, Hazrat-e Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran 2 Department of Neurology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence should be addressed to Ali Amini Harandi, amini alli@yahoo.com Received 12 October 2010; Revised 1 January 2011; Accepted 18 February 2011 Academic Editor: Vincenzo Di Lazzaro Copyright © 2011 Alireza Mohebbi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Rhino-orbital-cerebral zygomycosis aﬄicts primarily diabetics and immunocompromised individual, but can also occur in normal hosts rarely. We here presented an interesting case of facial nerve palsy and multiple cold abscesses of neck due to rhino-orbital- cerebral zygomycosis in an otherwise healthy man. Although some reports of facial nerve paralysis in conjunction with rhino- orbital-cerebral zygomycosis exist, no case of bilateral complete facial paralysis has been reported in the literature to date. 1. Introduction The most common clinical presentation of zygomycosis is rhino-orbital-cerebral infection. The former, and more com- mon, term “mucormycosis” is familiar to most clinicians. However, most mycologists prefer the term “zygomycosis” since other members of this class of fungi can also cause infection in the order Mucorales. Almost all patients with invasive zygomycosis have some underlying pathology that makes them susceptible to be infected. The most com- mon underlying diseases are diabetes mellitus, metabolic acidosis, treatment with glucocorticoids or deferoxamine, hematologic malignancies, solid organ transplantation, iron overload, acquired immunodeﬁciency syndrome, injection drug use, trauma, burns, and malnutrition [1]. 2. Case Report In October 2008 a 43-year-old previously healthy man presented to our hospital with complain of headache, unilateral facial numbness in the distribution area of V1 and V2 branches of trigeminal nerve, facial nerve paralysis, proptosis, blindness due to optic nerve involvement, nasal obstruction, nasal discharge and aural fullness, and hearing impairment in the right side. All these symptoms were developed during a 15-day period. The patient did not have any positive history regarding chronic rhinosinusitis, recent dental problems, or local surgeries. About 48 hours after admission, he developed left-sided complete facial nerve paralysis in all branches (Figure 1). Computed tomography scans of orbits, paranasal sinuses, temporal bone, and neck were performed. It demon- strated marked right proptosis, thickening of the extraocular muscles, opaciﬁcation of right maxillary, ethmoid and sphenoid sinuses, bilateral opaciﬁcation of mastoid air cells and middle ear spaces, as well as multiple cystic lesions in the neck (Figure 2). According to brain magnetic resonance imaging (MRI) brain stem and cavernous sinus remained intact. Consequently, extraocular muscles involvement was considered as cause of frozen eyes. Except V and VII other cranial nerves were normal. Biopsy of the involved tissues of his right nasal cavity and orbit conﬁrmed zygomyco- sis. Consequently, patient underwent radical debridement of all involved sinuses, orbital exenteration, incision and drainage of parapharyngeal abscess, and myringotomy and aspiration of middle ear eﬀusion. Histopathological eval- uation showed coagulative necrosis, blood vessels throm- bosis, and inﬁltration of broad, nonseptate hyphae with rightangle branching compatible with zygomycosis. Abscess ﬂuid sample was containing fungal elements but middle