For citation: Medvedev Yu.A., Ispiryan D.Kh. Optimization of surgical treatment of patients with drug-associated middle face zone necrosis. Golova i sheya. Rossijskij zhurnal Head and neck. Russian Journal. 2019;7(3):1: 28–35 (in Russian).
The main feature of recent years is the spread of synthetic narcotic drugs using handicraft products from codeinecontaining drugs.
Purpose: to increase the effectiveness of surgical treatment of patients with drug-associated facial middle zone osteonecrosis.
Material and methods. An examination and surgical treatment of 50 patients (41 men and 9 women) with facial middle zone osteonecrosis (ON) was performed in the clinic of maxillofacial surgery of the I.M. Sechenov First Moscow State Medical University from 2013 to 2017. The age of patients ranged from 22 to 40 years. ON of the facial bones was confirmed by the presence of exposure of the bone tissue in the jaw and / or bones of the facial skull for more than 2 months after any trigger mechanism action, for example, tooth extraction. All patients were divided into 4 groups: group 1 – patients with a limited osteonecrotic lesion (30%); 2nd group – patients with a diffuse osteonecrosis in the maxilla (28%); 3rd group – patients with osteonecrosis localized in the maxilla and the zygomatic bone body (22%); 4th group — patients with drug-associated ON of the maxilla, zygomatic bone, and lower orbital wall (20%). All patients underwent clinical, instrumental and laboratory studies. To assess pain, a digital rating scale was used before and after surgery. A microbiological examination of the discharge in the oral cavity and external fistulas was performed before and after the surgical treatment at the rehabilitation stage. Thirty patients underwent multispiral computed tomography of the facial skull.
Results. Partial unilateral maxillary resection from the intraoral access was performed in the 1st group. In the 2nd group, resection of maxilla and zygomatic bone was performed from extraoral access according to KocherWeber with a transition to the sub-ciliary access with simultaneous reconstruction with pedicle flaps from the cheek, nasolabial region, etc. In the 3rd and 4th groups, maxilla, zygomatic bone and lower orbital wall were resected from the Kocher-Weber access with a transition to the sub- and supra-ciliary access with simultaneous plastic grafts from the cheek, nasolabial and temporal region. Based on the obtained data, we analyzed the course of the early and late postoperative periods in patients with drug-associated ON of the middle facial zone. In all patients who followed the recommendations and did not start taking desomorphine again, we noted a persistent remission of the disease: no ON spread to the other regions detected, and the condition of the oral cavity was relatively good.
Key words: drug-associated osteonecrosis, midface, maxillary resection, zygomatic bone resection, economical resection, phosphoric, toxic osteonecrosis, temporal flap, desomorphine, facial skull
The authors declare no conflict of interest. Source of financing: not specified.
For citation: Medvedev Yu.A., Ispiryan D.Kh. Optimization of surgical treatment of patients with drug-associated middle face zone necrosis. Golova i sheya. Rossijskij zhurnal Head and neck. Russian Journal. 2019;7(3):1: 28–35 (in Russian).
The authors are responsible for the originality of the data presented and the possibility of pub-lishing illustrative material – tables, figures, photographs of patients.
摘要：
近年来的主要是使用含可待因药物的生产合成麻醉药品。
目的：提高与药物相关的面部中部骨坏死患者的手术治疗效果。
材料与方法： 2013年至2017年，在莫斯科第一莫斯科国立医科大学的颌面外科部门对50例面部中部骨坏死 （ON）患者（41名男性和9名女性）进行了检查和外科手术治疗。患者年龄从22岁到40岁。在任何触发机制作用 （例如拔牙）后两个多月内，面部颌骨或面部颅骨的骨组织暴露，从而确认了面部骨骼的ON状态。所有患者分为 4组：第1组–骨坏死病灶有限（30％）；第二组–上颌骨弥漫性骨坏死的患者（28％）；第三组–上颌骨和骨体 内骨坏死的患者（22％）；第四组-上颌骨，骨和下眶壁药物相关性ON的患者（20％）。所有患者均接受了临 床，仪器和实验室研究。为了评估疼痛程度，在手术前后均使用了数字评分表。进行了手术治疗之前和之后的康 复，对口腔和外瘘的排出物进行了微生物学检查。 30名患者接受了面部颅骨的多螺旋计算机断层扫描。 结果：第一组进行了从口内入路的单侧上颌部分切除术。在第二组中，根据Kocher-Weber的方法从口外入路切 除上颌骨和骨，然后过渡到睫状下入路，同时用颊、鼻唇沟等处的椎弓根皮瓣进行重建。从Kocher-Weber入路 切除上颌骨，骨和下眶壁，同时从脸颊，鼻唇沟和颞部同时移植材料至睫状下和睫状上入路。根据获得的数据， 我们分析了中面部面部药物相关性ON患者的术后早期和晚期过程。在所有遵循建议且未再次开始服用地索吗啡的 患者中，我们注意到该病持续缓解：未发现ON扩散到其他区域，并且口腔状况相对良好。 关键词：药物相关性骨坏死，中脸，上颌骨切除，骨切除，经济切除，含磷，毒性骨坏死，颞皮瓣，去甲吗啡， 面部颅骨。
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引用：Medvedev Yu.A., Ispiryan D.Kh. Optimization of surgical treatment of patients with drug-associated middle face zone necrosis. Golova i sheya. Rossijskij zhurnal = Head and neck. Russian Journal. 2019;7(3):1: 28–35 (in Russian).
作者对所提供数据的独创性以及发布说明性材料（表格，图表，患者照片）的可能性负责