Table 1.

Clinical presentation of six cases

Case no	Age/sex	Brief case history	Affected site	Orbital defect shape/size	Surgical intervention	Maxillo-facial prosthetic rehabilitation
1	50yrs/M	Chief Complaint: patient presented with a complaint of pain & swelling on left side of the face and tooth bearing region of upper left jaw with an inability to open left eye since 1 month Past Medical History: Under oral medication for COVID-19 Induced diabetes mellitus type II COVID-19 History: Positive with history of oxygen therapy by mask Vaccination history: not vaccinated extraoral and intraoral clinical examination revealed: Left eye: proptosis, ptosis, oedema, conjunctival congestion, loss of vision Left maxilla and palate: Bony segmental mobility of anterior and posterior left maxilla at the level of Lefort-1 level along with unilateral necrotic mucosa and slough on hard palate. Restricted mouth opening about 2 fingers Histopathological examination: aseptate irregular branch fungal hyphae suggestive of Mucormycosis MRI Brain + PNS + Orbit: Sinusitis with left orbital cellulitis, inflammatory changes involving soft tissues of left infraorbital region, bilateral premaxillary region, spenopalatine fossa, infratemporal fossa & masticator spaces. left ICA appears to be attenuated in calibre and non-specific white matter changes	Left eye Left maxilla	Shape–oval Superior to inferior =  3.5 cm Medial to lateral = 4.0 cm	Left orbital exenteration Left infrastructure maxillectomy with left palatectomy	Left adhesive retained silicone based orbital prosthesis Heat cured acrylic obturator
2	65yrs/M	Chief complaint: patient presented with a complaint of pain & swelling on right side of the face with drooping of right eyelid along with pain while chewing and slurring of speech since 2 weeks Past Medical History: Under oral medication for diabetes mellitus type II since 2 years COVID-19 History: Positive with history of hospitalization Vaccination history: not vaccinated Extraoral and intraoral clinical examination: Right eye: proptosis, ptosis, oedema, conjunctival congestion, hazy lens, loss of vision Right Maxilla & Palate: Pale palatal mucosa with bony segmental mobility from 12 to17 region along with grade III tooth mobility of 11 and 21 Histopathological Examination: Broad aseptate hyline hyphae with wide angle branching suggestive of Mucormycosis CT Brain + Orbit + PNS: Pansinusitis with right side periorbital and orbital cellulitis of fungal etiology. Right cavernous sinus thrombo phlebitis and right ICA thrombosis	Right eye Right Maxilla	Shape -rhomboid Superior to inferior = 3.0 cm Medial to lateral = 4.0 cm	Right orbital exenteration Right infrastructure maxillectomy with right palatectomy	Right adhesive retained silicone based orbital prosthesis Heat cured acrylic obturator
3	45yrs/M	Chief complaint: patient’s attendant expressed aesthetic concern with respect to facial defect after left eye exenteration which was performed approx. 6 months ago Past medical history: under oral medication for diabetes mellitus type II since 8 years COVID-19 history: positive with history of hospitalization Vaccination history: not vaccinated Extraoral and intraoral clinical examination: Left Eye: satisfactory healing with respect to exenteration socket Right eye: loss of vision, proptosis, ptosis, oedema, swelling near medial canthus Intraorally no abnormality visualized Histopathological examination: chronic inflammation with interspersed broad, non-septate fungal hyphae suggestive of mucormycosis MRI Brain + Orbit + PNS: bilateral orbital & pre-septal cellulitis with bilateral optic neuritis and abnormal soft tissue inflammatory changes involving medial wall, extra-ocular muscles and floor of left orbit. bilateral pansinusitis, acute infarcts (?) septic in bilateral frontal,central semi ovale & left occipital lobe and bilateral intracranial ICA thrombosis	Left and right eye	Shape of left eye defect –rhomboid Superior to inferior = 2.5 cm Medial to lateral = 4.5 cm	Left orbital exenteration	Left adhesive retained silicone based orbital prosthesis
4	55yrs/F	Chief complaint: patient’s expressed aesthetic concern with respect to facial defect after right eye exenteration which was performed approx. 7 months ago Past Medical History: Under oral medication for COVID-19 Induced Diabetes Mellitus Type II COVID-19 history: positive with history of hospitalization Vaccination history: not vaccinated Extraoral clinical examination: satisfactory wound healing with respect to right eye exenteration socket Histopathological examination: broad aseptate hyline hyphae with wide angle branching suggestive of Mucormycosis CT orbit with contrast: bilateral ethmoidal, frontal, sphenoidal & left maxillary sinusitis. multiple areas of bony erosion along medial & inferior wall of right orbit with few adjacent coarse air attenuation foci reaching up to superior orbital fissure	Right eye	Shape–rhomboid Superior to inferior = 2 cm Medial to lateral  = 3.9 cm	Right orbital exenteration	Right adhesive retained silicone based orbital prosthesis
5	65yrs/F	chief complaint: presented with nasal regurgitation of food and aesthetic disfigurement due to missing left and associated facial structures Past medical history: under oral medication for hypertension since 10 years & COVID-19 Induced diabetes mellitus type II COVID-19 history: history of steroid medication while being COVID-19 positive Vaccination history: not vaccinated Extraoral clinical examination: satisfactory wound healing with respect to right eye exenteration socket Histopathological examination: panophthalmitis, foreign body granulomatous reaction & necrosis along with broad aseptate hyline hyphae with wide angle branching suggestive of Panophthalmitis with Mucormycosis MRI Brain + Orbit + PNS: right orbital cellulitis. bilateral pansinusitis. inflammatory changes involving soft tissues of bilateral pre-maxillary regions, medial canthus & infra-orbital regions, sphenopalatine fossa, infratemporal fossa & masticator spaces. chronic lacunar infarct in head of right caudate nucleus. chronic small vessel ischemic changes in Right Centrum semiovale and subcortical white matter of right frontal & right parietal lobe. mild cortico-cerebral atrophy	Right eye	Shape -rhomboid Superior to inferior = 4 cm Medial to Lateral = 3.5 cm	Right orbital exenteration	Spectacle retained silicone based orbital prosthesis
6	18yrs/M	Chief Complaint: Patient expressed aesthetic concern with respect to facial defect after left eye exenteration which was performed approx. 7 months ago past medical history: under oral medication for COVID-19 Induced diabetes mellitus type II COVID-19 History: Positive with history of hospitalization Vaccination history: not vaccinated Clinical examination: satisfactory wound healing with respect to left eye exenteration socket Histopathological examination: non-septate hyline hyphae with wide angle branching suggestive of Mucormycosis MRI PNS + brain + orbit: left orbital cellulitis. thrombosed left superior ophthalmic vein, left ICA & Left cavernous sinus possibly secondary to left sided invasive fungal pansinusitis (mucormycosis?)	Left eye	Shape–oval Superior to inferior = 2.5 cm Medial to lateral = 3.5 cm	Left orbital exenteration	Spectacle retained silicone based orbital prosthesis