Maxillary osteomyelitis is a rare event. With emergence of bisphosphonates, the incidence of jaw osteomyelitis has increased. We report five uncommon cases, with a comprehensive review of etiology and pathology. The correlation between osteonecrosis and osteomyelitis is discussed.

A case series of uncommon causes of maxillary osteomyelitis: Understanding the pathology and recognizing the risks.

Opioid addiction has acquired the characteristics of an epidemic in recent years and is a serious problem in modern medicine. In users of narcotic substances, a significant prevalence of diseases of the oral cavity and periodontal tissues is noted in comparison with the general population. The aim of the work was to investigate the ultrastructural organization of the periodontal tissues of rats at the end of the fourteenth week of the experimental opioid effect. The animals were administered intramuscularly, daily, once, the opioid analgesic nalbuphine (pharmacotherapeutic group: analgesics, opioids, morphinan derivatives) in increasing doses for 14 weeks: 1-2 weeks – 0.212 mg/kg, 3-4 weeks – 0.225 mg/kg, 5-6 weeks – 0.252 mg/kg, 7-8 weeks – 0.260 mg/kg, 9-10 weeks – 0.283 mg/kg; 11-12 – 0.300 mg/kg, 13-14 weeks – 0.450 mg/kg. At the end of the fourteenth week of opioid exposure, ultrastructural changes in the epithelium of the mucous membrane of the gums, periodontium, and hemomicrovessels with the development of decompensation and pronounced dystrophic-destructive changes were established. With the long-term effect of an opioid analgesic, signs of karyorrhexis, segregation of nucleoli, spongiosis, apoptosis, violation of the integrity of intercellular contacts, as well as vacuole-like formations, which were a manifestation of focal necrosis of epitheliocytes, were revealed. The development of necrotic changes was caused by significant damage and destruction of organelles, as well as fragmentation or lysis of bundles of tonofilaments. The intercellular spaces were mostly expanded and uneven, which was caused by edematous phenomena. Fragmentation and destruction of periodontal collagen fibers, destructive changes in fibrocytes and fibroblasts were found in the periodontium. The translucency of the amorphous component of the intercellular substance of the connective tissue was determined. The ultrastructural reorganization of the cellular components of the periodontium was caused by vascular disorders of a systemic nature, which were manifested by the phenomena of dilatation, hemoptysis, sludge phenomenon, dystrophic changes in the endotheliocytes of hemocapillaries and venules, and the progression of sclerotic changes, which significantly disturbed the trophism of the periodontal tissues of rats.

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Ultrastructural reorganization of the constituent components of the rat periodontium under conditions of chronic opioid exposure

OBJECTIVE The aim: The aim of our research is to study the features of toxic osteomyelitis in drug addicts, their diagnosis and comprehensive treatment, aimed at strengthening motivation for the suspension of the use of psychoactive substances and the elimination of the pathological process in the lower jaw PATIENTS AND METHODS Materials and methods: The features of toxic osteomyelitis, complicated by abuse, have been studied on 46 patients in the department of oral and maxillofacial surgery of Lviv regional clinical hospital during 2013-2019 Psychoactive substances, used by the patients, varied from homemade drugs "Screw" taken by 32 men (695%), synthetic drug amphetamine consumed by 10 men (21,7%) to Subutex used by 4 patients (8,7%) for their pleasure All the patients underwent comprehensive examination, which included clinical, laboratory, radiological, pathohistological studies Almost all patients - 41 ( 891% ) underwent sequestrectomy RESULTS Results: Clinical picture progressed quite rapidly in the form of diffuse destructive-necrotic osteomyelitis of the mandible, which was characterized by a severe, atypical course of the pathological process with permanent inclusion of other additional areas of the lesion of the mandible The X-ray at this stage showed an increase in destructive processes in the bone CONCLUSION Conclusions: Appropriate surgical tactics and pathogenetic therapy are of great importance for toxic osteomyelitis in drug addicts Due to the treatment, despite the total destruction of the mandible, it was possible to stop the destructive bone processes and to preserve life for such patients

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Andriy Netlyukh

Papers

Clinical features of toxic jaw bone osteomyelitis in drug addicts.