Clinical cases of atypical osteonecrosis of the facial bones in patients with type 2 diabetes

A feature of recent years is the spread of cases of osteonecrosis (ON) of the facial bones which occur as a result of radiation and chemotherapy during the treatment of malignant tumors, of the synthetic drugs abuse, as well as of antiresorptive drugs usage in the treatment of osteoporosis. To date, ON can conditionally be divided into two groups: radiation and drug-associated. Numerous systemic and local factors can contribute to the ON development. A growing body of evidence confirms that diabetes is an important risk factor for this disease. Two clinical cases of complex treatment of patients with ON of the facial bones and type 2 diabetes mellitus are presented. At the outpatient stage, patients underwent laboratory, clinical, and radiological examinations. The first patient underwent resection of the upper jaw from extraoral access according to Kocher-Weber. After 6 months, the 2nd stage of surgical treatment was performed in the amount of the plastic surgery of the orbital cavity bottom defect using an individualized mesh implant, plastic surgery of the defect of the anterior maxilla with a split skin autograft. The second patient underwent surgery in the amount of resection of the upper jaw on the left, and bones of the left zygomaticoorbital zone from extraoral access according to Kocher-Weber. Currently, patients are under the supervision of an endocrinologist, receiving an adequate conservative therapy. Persistent remission of the disease is noted.

Key words: drug-associated osteonecrosis, facial skeleton, upper jaw resection, zygomatic bone resection, economical resection, desomorphine, diabetes mellitus.

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study.

For citation: Dzhirgalov O.V., Medvedev Yu.A., Kutsenko R.V. Clinical cases of atypical osteonecrosis of the facial bones in patients with type 2 diabetes. Golova i sheya. Rossijskij zhurnal  Head and neck Russian Journal. 2020;8(2):65–71 (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.