Etiology, clinical features, and management strategies in orofacial rhinosporidiosis: a systematic review

Background: Rhinosporidiosis, caused by Rhinosporidium seeberi, mainly affects the nasal mucosa but can also involve orofacial sites such as the oral cavity, maxillary sinus, and buccal mucosa, complicating diagnosis and treatment. Endemic in India, Sri Lanka, and parts of South America, infection is linked to stagnant water exposure, yet orofacial cases remain underreported with limited management guidance. Methodology: This systematic review followed PRISMA guidelines to ensure transparency. Comprehensive searches of PubMed, Scopus, Web of Science (2012–2025) identified 238 records, with 16 studies included after screening. English-language case reports and series reporting clinical, diagnostic, or therapeutic data on orofacial rhinosporidiosis were considered eligible. Data was extracted using standardized forms, and study quality was assessed with the Joanna Briggs Institute checklist, evaluating selection, reporting, and outcome bias. Results: Analysis of reported cases shows that orofacial rhinosporidiosis primarily affects young to middle-aged men, with females rarely affected. Patient ages ranged from 10 to 65 yr. Frequently involved sites include the nasal cavity, maxillary sinus, and nasopharynx, with occasional lesions in the oral cavity, oropharynx, buccal mucosa, and palate; disseminated involvement of subcutaneous tissues or lungs is rare. Lesions are polypoid, reddish, friable, and “strawberry-like”, with symptom duration spanning weeks to 20 yr. Diagnosis is confirmed via histopathology, with imaging used selectively. Surgical excision with electrocauterization, often supplemented by Dapsone, yields favorable outcomes. Follow-up ranged 3–36 months, with minimal complications, though rare hemolytic anemia was reported. Conclusion: Orofacial rhinosporidiosis primarily affects young to middle-aged men, presenting as polypoid, “strawberry-like” lesions that require histopathological confirmation for diagnosis. Surgical excision with electrocauterization, supplemented by Dapsone when appropriate, provides effective management, though long-term follow-up is essential to monitor for recurrence.