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Abstract

In India, the second wave of COVID-19 caused by Corona virus-19 was associated with sudden increase in opportunistic fungal infection of Mucormycosis. At our center we reported 9 patients who presented with facial palsy along with mucormycosis (post COVID-19), which is a rare presentation and has been sparsely reported. To identify the possible pathogenesis for the route of spread for involvement of the facial nerve in cases of rhino-orbito-cerebral mucormycosis. To assess the prognosis and recovery of facial palsy in patients with post COVID-19 Mucormycosis patients. The study was carried at a rural tertiary center in Western India. Out of a total 108 patients proven Mucormycosis, 9 patients reported with LMN facial palsy. They underwent thorough evaluation and received medical line of treatment followed by repeated surgical debridement. Observational case series. The possible routes that affect the Facial Nerve could be, (a) involvement of the infratemporal fossa (pterygopalatine fossa) extending to the stylomastoid foramen area with perineural invasion, (b) extension through the sphenoid sinus to nasopharynx following the eustachian tube to middle ear and then the facial nerve, (c) spread via the vidian nerve to Greater superficial Petrosal Nerve, (d) diabetic neuropathy(mononeuritis) and (e) incidental Bell’s. At the end of 2 years, in 3 patients the facial palsy improved from Grade V to Grade II House Brackmann score, in 3 patients the facial palsy did not show improvement and 3 patients succumbed to the mucormycosis with pulmonary and cerebral complications. The overall prognosis of patients with facial palsy in Covid-19 associated mucormycosis remains poor. LMN facial Palsy could be a first presenting feature of COVD-19 associated neuropathy or COVID Associated Mucormycosis.

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Data Availability

The patients admitted in the ENT department for mucormycosis who were willing to be a part of the study were included No competing interests.

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Acknowledgements

Special thankyou to all patients for participating in the study.

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No funding was required for the study.

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SB did data collection, review of literature and interpreted the data for the manuscript. AY played an important role in conceptualization of the manuscript and suggested corrections in the paper. AL gave guidance and supervised the manuscript writing KK helped in statistical analysis and together all the authors formulated the Manuscript.

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Correspondence to Sai Belsare.

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Was taken from Institutional Ethical Committee of Yashwantrao Chavan Memorial Hospital correspondence letter number being YCMH/IEC/KAVI/1/63/2021 and written informed consent to participate was taken from the patients.

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Belsare, S., Yeolekar, A., Kahane, K. et al. Facial Nerve Palsy in COVID-19 Associated Mucormycosis. Indian J Otolaryngol Head Neck Surg (2025). https://doi.org/10.1007/s12070-025-05678-z

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