Physical examination should be complemented by full nasal endoscopy. Necrotic areas or sites of mucosal ulceration should be biopsied for immediate frozen section analysis (22). The presence of characteristic fungal hyphae invading the tissue confirms the diagnosis. The hyphae of zygomycetous fungi are broad and irregularly branched and have rare septations. This is in contrast to the hyphae of Aspergillus, which are narrow and have regular branching and septations. Special stains and fungal cultures can identify the species; however, these studies take too long to be of use in the initial management. Furthermore, these pathogens are notoriously difficult to culture.
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