DOI: 10.35556/idr-2019-4(89)22-27.

The treatment of osteonecrosis of the jaws in patients with dependence on “self-made dezomorphine»
Nesterov A.A., Yakhyaeva E.R., Tulaeva E.V.
Astrakhan State Medical University, Department of oral and maxillofacial surgery
414000, Russian Federation, Astrakhan region, Astrakhan, Bakinskaya St., bld. 121.

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The article is devoted to the influence of «self-made dezomorhine» on pyo-inflammatory disease of maxillofacial area. This project is topical in Russian Federation, because the quantity of drug addicts grows every year. Maxillofacial area is a high risk zone for development of inflammatory process due to the high probability of the chronic odontogenic center of infection and because of special aspects of blood supply and innervation of this area. Special attention must be payed to the jaws osteonecrosis of the jaws, which develop after «self-made dezomorhine» ingestion. Dezomorhine is a narcotic analgesic, which is banned in Russian Federation. From 2008 to 2014 there was conducted the treatment of 84 patients from age19 to 55 years of both sexes with local and diffuse osteonecrosis of the jaws, which began after «self-made dezomorhine» in department of maxillofacial surgery of Astrakhan Aleksandro-Mariinskaya Regional Clinic Hospital, 2 patients of the whole number of operated patients died because of the overdose of drugs, and 1 patient died due to the septic accident during the period of monitoring. It was found that as a result of retrospective analysis post evaluation procedures make it possible to affirm, that if the operation was performed in the course of 6 months after the intermission of taking drugs, the necrotic process usually extends to nearby areas of the jaws after the implementing of the necroectomy. The best results of the treatment were achieved when patients applied for hospital treatment after 6 to 12 months following the intermission of taking of «self-made dezomorphine». The article deals with 2 medical cases, illustrated by X-Ray pictures and clinic photos. 205 operations were performed by the 6 years’ experience of the treatment of 84 patients with «dezomorphinic» osteonecrosis of the jaws and it enables us make a conclusion, that classic surgeon treatment is the most preferable variant. The classic treatment includes surgery after the appearance of demarcation zone and sequesters organization. The detoxication therapy, immune-enhancing therapy, anemia treatment and usage of antibiotics are the important parts of the treatment, as well as the antibiotic use. Provided the specific microflora and typical status of immune system phenomenon occurred in the process of complex treatment of «dezomorphinic» necrosis of the jaws, we, applied a course of semisynthetic macrolides. We mostly applied Roxithromycinum in a dose of 150 mg in tab. 2 b.d.s. with the interval of 12 hours; period of treatment lasts 5 days. Rational antibiotic treatment allows to prognosticate a successful result of the treatment of «dezomorphinic» osteonecrosis of the jaws.

Keywords: osteonecrosis, desomorphine, drug abuse, bisphosphonates.

For citation: Nesterov A.A., Yakhyaeva E.R., Tulaeva E.V. The treatment of osteonecrosis of the jaws in patients with dependence on “self-made dezomorphine». Stomatology for All / Int. Dental Review. 2019; No.4(89); 22-27 (In Russian). doi: 10.35556/idr-2019-4(89)22-27

1. Basin E.M. Toxic phosphorus necrosis of the facial skull: abstract. … Dr. med. sciences’. Moscow, 2017: 48 p.
2. Zhabina A.S. Role of bisphosphonates for prevention and treatment of bone metastases. Practical Oncology. 2011; No. 3: 124-131.
3. Ovrutsky G.D. Chronic odontogenic focus. Moscow: Medicine, 1993, 144 p.
4. Ilyina N.I. et al. Syndrome of secondary immune insufficiency. Immunology. 2000; No. 5: 8-9.
5. Poghosyan Yu.M., Hakobyan K.A., Manukyan E.V. Bisphosphonate osteonecrosis (background) of the upper jaw in a patient with multiple myeloma. Questions of theoretical and practical medicine. 2011; No. 5: 39-42.
6. Timofeev A.A. Features of the clinical course of odontogenic inflammatory diseases of the jaw and soft tissues in patients with drug addiction and HIV-infected. Modern dentistry. 2006; No. 2: 88-95.
7. Timofeev A.A., Was Ducal A.V., Kishkovskaya E.N. The clinical course of the odontogenic inflammatory diseases of the jaws and soft tissues in patients with narco-mania. Modern dentistry. 2009; No. 1: 94-98.
8. Shargorodsky A.G. Inflammatory diseases of tissues of maxillofacial region and neck. Moscow: go VUNMTS, 2001, 272 p.
9. Hughes J.P.W., Baron R., Buckland D.H., Cooke M.A., Craig J D., Duffield D.P., Grosart A.W., Parkes P.W.J., Porter
A. Phosphorus necrosis of the jaw: a present-day study. Brit. J. industr. Med. 1962; 19: 83—99.
10. Marx R.E., Cillo J.E., Jr, Ulloa J.J. Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment. J Oral Maxillofac Surg. 2007; 65(12): 2397—2410.
11. Pallasch T.J. Antimicrobials and periodontal-disease — quo-vadis. The International journal of periodontics & restorative dentistry. 1988; 18(3): 212—213.
12. Uhl W. Infections complicating pancreatitis: diagnosing, treating, preventing / W. Uhl, R. Isenmann, M.W. Buchler. New. Horiz. 1998; №2: 72—79.