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Although most cases originate from developing countries, an ageing population and increased prevalence of chronic illness may mean some clinicians practicing in developed countries will encounter ROCM cases in their careers. Yohai et al published a systematic review of 145 case reports from 1970 to 1993 assessing prognostic factors for patients presenting with ROCM. We present an updated review of the literature and assess whether survival outcomes have changed in the two decades since that seminal paper.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>An extensive Medline literature search was performed for case reports published between 1994 and 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 210 published cases were identified from the literature review, of which 175 patients from 140 papers were included in this review. Fifty\u2010five were female, with an overall mean age of 43 years. Overall survival rate was 59.5%, which was not significantly better than the previous series reported (60%) reported by Yohai et al. Survival rates in patients with chronic renal disease had improved, from 19% to 52%, and in patients with leukaemia (from 13% to 50%). Facial necrosis and hemiplegia remained poor prognostic indicators (33% and 39% survival rates, respectively). Early commencement of medical treatment related to better survival outcomes (61% if commenced within first 12 days of presentation, compared to 33% if after 13 days). Timing of surgery had less of an effect on overall survival. However, in 28 cases that did not receive any surgical treatment, survival was only 21%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although overall survival rates have not improved, survival in patients with renal disease were better, potentially due to the introduction of liposomal amphotericin B which is less nephrotoxic. Prompt recognition of ROCM, reversal of predisposing co\u2010morbidities and aggressive medical treatment remain the cornerstone of managing this highly aggressive disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13175","type":"journal-article","created":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T06:39:21Z","timestamp":1530081561000},"page":"1454-1464","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":116,"title":["A meta\u2010analysis of survival factors in rhino\u2010orbital\u2010cerebral mucormycosis\u2014has anything changed in the past 20 years?"],"prefix":"10.1111","volume":"43","author":[{"given":"Casey","family":"Vaughan","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology \u2010 Head and Neck Surgery Aintree University Hospital NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5246-4769","authenticated-orcid":false,"given":"Amanda","family":"Bartolo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2010 Head and Neck Surgery Aintree University Hospital NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimisha","family":"Vallabh","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2010 Head and Neck Surgery Aintree University Hospital NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7213-0387","authenticated-orcid":false,"given":"Samuel C.","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2010 Head and Neck Surgery Aintree University Hospital NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6257(05)80041-4"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/432579"},{"key":"e_1_2_8_4_1","unstructured":"CoxGM.Mucormycosis (zygomycosis). 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