Optimization of surgical treatment of patients with drug-associated middle face zone necrosis
The main feature of recent years is the spread of synthetic narcotic drugs using handicraft products from codeine-containing 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 Kocher-Weber 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.