The article presents review of the literature on the current state of the problem of bisphosphonate-related osteonecrosis of the jaw. In Russia and abroad there are numerous reports of atypical lesions of the maxilla associated with taking medications on the basis of phosphorus or its analogues, in particular bisphosphonates. This is an issue: if earlier bisphosphonate treatment complications were limited to individual clinical observations, currently their frequency, according to different authors, reaches 8-27%. Bisphosphonate-related osteonecrosis of the jaw is characterized by unique etiopathogenic, clinical and diagnostic features that distinguish it from other inflammatory, degenerative and iatrogenic diseases of orofacial region, so it is reasonable to isolate it into an independent nosology, requiring a comprehensive study. According to current data, bisphosphonate-related osteonecrosis of the jaw is a complication of antiresorptive therapy, characterized by necrosis and exposure of bone area, which persists for more than 8 weeks, followed by the process progression in the absence of radiation therapy to the head area in history. Bisphosphonates are antiresorptive agents, potent inhibitors of bone tissue destruction, widely used for the treatment of bone metastasis, multiple myeloma, and hypercalcemia in cancer patients. However, the development of complications such as osteonecrosis of the jaw greatly reduces the positive effects of treatment, and extremely bothersome for patients. Osteonecrosis-related pyo-inflammatory processes of admaxillary tissue, the appearance of persistent sinus tracts on the skin and in the mouth, the risk of pathologic fracture of the jaw impair the quality of life of patients. Presented in the article analysis of currently known data about the bisphosphonate-related osteonecrosis of the jaw should attract the attention of dental surgeons, maxillofacial surgeons, endocrinologists, oncologists to this problem.
The review article is devoted to one of the new topical problems in medicine necrosis of the organs of the cranio-maxillofacial region in patients with coronavirus infection, which was first discussed at the end of 2020. Later, doctors of various specialties (otolaryngologists, ophthalmologists, maxillofacial surgeons, neurosurgeons, dentists) from many countries of the world met in their practice with inflammatory-necrotic lesions of the mucous membrane of the nasal cavity and paranasal sinuses, facial skeleton and skull, eyeball, brain. The article highlights the main points of view of scientists about the etiology and pathogenesis of the studied pathology. Summarized data from the largest studies on the epidemiology, risk factors, and symptoms of post-covid necrosis of the cranio-maxillofacial region are presented. The results of various methods for diagnosing this complication multislice computed tomography, magnetic resonance imaging, angiography, are described in detail. Due to the fact that today the role of fungal flora is recognized as the leading one in the etiology of post-covid necrosis of the cranio-maxillofacial region, much attention is paid to cytological, microbiological and pathohistological research methods, which should be aimed at the search for mycelium. The main approaches to the treatment of patients with this pathology are formulated. The article highlights issues important for practical healthcare: interpretation of national clinical guidelines for coronavirus infection in terms of post-covid necrosis of the cranio-maxillofacial region, classification options according to the International Classification of Diseases of the 10th revision, the procedure for providing medical care to this category of patients, the economic consequences of the lack of active prevention methods of the presented complication in patients with COVID-19.
The occurrence of drug-induced osteonecrosis of the jaw in cancer patients treated using bone-modifying medications (bisphosphonates and denosumab) is a highly relevant research problem studied by dentists, maxillofacial surgeons, and oncologists. Despite the large number of publications, practical approaches to preventing drug-induced osteonecrosis of the jaw remain to be developed, which is confirmed by the increasing prevalence and severity of the clinical course of the disease. In this article, we review the most significant works and position papers published in Russia and abroad over the past 10 years, as well as the authors’ scientific and clinical experience, in order to identify key reasons behind the ineffective prevention of drug-induced osteonecrosis of the jaw in cancer patients and to suggests possible solutions. Questions concerning the legal protection of patients and clinicians in relation to this complication are discussed. Most recent achievements in the field of laboratory diagnostics and risk assessment of drug-induced osteonecrosis of the jaw in cancer patients, including the determination of bone metabolism markers, are presented. The following criteria for the safe use of bisphosphonates and denosumab in cancer patients were identified: dental screening; clinical and laboratory monitoring; individualizing drug dosage, duration and withdrawal regimens; application of an interdisciplinary approach.
Dentists are always in quest of new methods for the treatment of periodontal diseases, and photodynamic therapy (PDT) is considered one of the most effective methods. A significant improvement in the clinical pic-ture was obtained in all patients throughout the control period of observation of the patients as a result of the treatment with the use of PDT. According to the data from research study it can be said that photodynamic therapy is an effective and gentle method of antibacterial treatment of inflammatory periodontal diseases, which can be effectively used to prevent exacerbations of chronic inflammatory periodontal diseases, to achieve a long-term positive effect and to refuse, in some cases, from surgical methods of treatment. There is a signifi-cant increase in the duration of remission of the disease, improvement of microcirculatory blood circulation in per-iodontal tissues and a small microbial contamination of periodontal pockets of patients treated with photodynam-ic therapy in the long term compared with groups of patients treated with only antiseptic and antibacterial drugs.
На сегодняшний день БОНЧ -одна из актуальных проблем в челюстно-лицевой хирургии и хирургиче-ской стоматологии, рассматриваемая с множества точек зрения, иногда взаимоисключающих. С ростом заболеваемости онкологической патологией можно утверждать, что количество таких осложнений будет увеличиваться [4].В литературе по данной тематике в описании гисто-логической картины операционного материала, полу-ченного у больных БОНЧ, единства не обнаружено. Не-которые исследователи [5, 6] указывают на выраженный воспалительный характер изменений в мягких тканях челюсти с участками некроза и остеолизиса костной ткани, наличие сосудистой реакции без инфильтрации. Другие описывают асептический некроз с отсутствием характерных признаков воспаления [1]. Однако в лите-ратуре отсутствуют даже попытки проведения аналогий между гистологическими данными и особенностями те-чения клинической картины БОНЧ; не изучена диагно-стическая ценность патогистологического метода для прогнозирования исходов заболевания.Цель исследования -сопоставить клиническое течение бисфосфонатного остеонекроза с индиви-дуальными данными гистологической картины забо-левания, определить информативность патогистоло-гического метода у больных с БОНЧ с точки зрения прогнозирования исходов заболевания.Материал и методы. В отделении челюстно-лицевой хирургии за 2011-2014 годы обследовано 30 больных с бисфосфонатным остеонекрозом че-люстей. Среди них преобладали женщины (56,67 %). Наивысшая частота встречаемости остеонекроза зафиксирована у пациентов возрастной категории 60-65 лет (50 %), с раком молочной железы (60 %).Десяти пациентам была оказана паллиативная помощь без гистологического исследования кости, чтобы исключить дополнительное инфицирование. stavropol state medical university, russiaПроведен анализ клинического течения бисфосфонатного остеонекроза челюстей (БОНЧ) в сопоставле-нии с гистологическими данными. Гистологическая картина костной ткани при БОНЧ является неоднородной, определены три основных ее вида. Результаты доказывают, что в прогнозировании исходов и успешности лечения бисфосфонатного остеонекроза возможно использование результатов гистологического исследо-вания. Ключевые слова: бисфосфонаты, остеонекроз, гистологическое исследованиеClinical course of jaws bisphosphonate osteonecrosis is analyzed in comparison with the obtained histological data. The histological picture of the bone tissue in jaw bisphosphonate osteonecrosis is heterogeneous; its three main types are identified. The results demonstrate that the results of histological examination may be used in prediction of outcomes and successful treatment of bisphosphonate osteonecrosis.
Subject. Postcovid necrosis of the maxillofacial region is one of the severe consequences of a new coronavirus infection, the etiology and pathogenesis of which are not fully understood. A large number of researchers emphasize the leading role of molds in the development of this complication, which they characterize as COVID-19-associated rhino-orbito-cerebral mycosis. However, there is a point of view that the inflammatory process in post-covid necrosis can also be caused by other pathogens - saprophytic microflora. The aim of the study was to evaluate the results of microbiological examination in patients with Postcovid necrosis of the maxillofacial region and in the risk group for this complication. Methodology. The main study group consisted of 19 patients with signs of osteonecrosis of the bones of the facial skeleton and inflammatory lesions of the paranasal sinuses after suffering a coronavirus infection (Postcovid necrosis of the maxillofacial region). Control group (risk group) - 32 patients with severe COVID-19 without the above manifestations. A microbiological study was performed - a smear from the mucous membrane in the region of the middle nasal passage, smear microscopy, seeding on standard and elective (Saburo) media before treatment. Data were compared using Fisher's exact test for p<0.05. Results. In the main group there were 19 people - 10 men (52.63%), 9 women (47.37%), aged 54 to 73 years, in the control group - 18 (56.25%) men, 14 (43, 75%) women, 52 to 83 years old. In the main group, Streptococcus viridans, Klebsiella pneumonia and Mucor spp. were detected significantly more often (p<0.05), and Staphylococcus aureus was found in the risk group. Mycelium of mold fungi was found only in 3 patients of the main group, in the rest the absence of fungal invasion was confirmed cytologically and pathohistologically. Conclusions. The data obtained confirm the assumption that the inflammatory process in Postcovid necrosis of the maxillofacial region can be caused by various pathogens and is an opportunistic nosocomial infection. It is required to monitor patients at risk and timely treatment if they develop specific symptoms.
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