Characteristically, the biopsy is bloodless in advanced disease because of arterial invasion of fungal hyphae. In addition to the ENT exam, imaging studies can also be very helpful in the evaluation of possible mucormycosis, although the radiologic appearance may not be diagnostic. Complications of mucormycosis can be severe and occur more frequently with delayed diagnosis. Cranial nerve defects can be seen with fungal invasion of orbital vessels leading to necrosis of intraorbital nerves. Cavernous sinus thrombosis can readily occur with invasion of the organism into the cavernous sinus.
Intracranial spread can occur via the cribriform plate.
Strokes have been reported with mucormycosis spreading from the cavernous sinus to the internal carotid artery. The currently accepted treatment of choice is intravenous amphotericin B. Local irrigation and liposomal administration of amphotericin has also been advocated. Surgical debridement is frequently needed to control the spread of the fungus. Attempts to treat the disease have also been made using hyperbaric oxygen therapy and other antifungal agents. Physicians must have a high index of suspicion in order to diagnose and treat mucormycosis in its earliest stages when clinical symptoms are the most subtle.