Mutilating Lesions of Face.

The destructive lesions affect midline facial areas causing extensive destruction. These lesions are challenging till date due to peculiarity in presentation and non availability of any single objective test. An attempt has been done to evaluate these different clinical presentations of lesions presenting at a single centre and the challenges faced by us at a tertiary government setup. Prospective study done on 15 patients presenting in department during period of 2006-2016. After a detailed history, hematological and biochemical markers, ESR, radiographical tests, pus culture, C ANCA, CECT PNS and histopathogical evaluation were done. 12 out of 15 patients were male; Most common age group was above 45 years of age. All cases had ulceration of nose, 9 had cartilaginous destruction and 3 had osseocartilaginous destruction. 5 cases of mucormycosis had hyperglycemia with 2 having ketonuria and 4 had nerve palsies. All patients needed multiple biopsies. 3 cases of wegners and 4 cases were suspected of IMDD and immunohistochemistry was advised. C ANCA was negative in wegners cases as they were in limited form. Mutilating diseases of face usually present at an advanced stage with diverse etiology, are slowly progressive and require detailed evaluation. Due to lack of availability of IHC markers and C-ANCA at every centre it is difficult to diagnose them. The treatment is challenging due to incomplete response and frequent relapses. These cases require proper work up plan and perseverance leads to a final diagnosis.