Український стоматологічний альманах (Mar 2015)
CLINICAL SYMPTOMS OF TOXIC OSTEOMYELITIS DEPENDING ON THE TIME OF DRUG USE
Abstract
The article discusses peculiarities of clinical appearances of toxic jaws osteomyelitis depending on drugabuse and abandonment terms. Task: specific clinically features of toxic jaws osteomyelitis investigation, depending on the term of drug abuse. Materials and methods: clinical research was held in the maxillofacial department of Kharkov state clinical hospital. 78 patients with chronic toxic jaws osteomyelitis were examined clinically, laboratory tested for clinical blood tests, hepatitis B and C, HIV infection. X-ray investigations, such as CT and cone beam computed tomography were made. The detailed anamneses of the diseases development were taken. Special attention was given to the duration of drug abusing and to the abandonment terms. Results and discussion: all the patients admitted the abusing of a self-made amphetamine – pervitin. An average abuse term was 2,6 years. The abandonement of drug abusing is important, for along with the narcologiс dependence cessation comes the termination of depositing toxic substances, which cause the disease development. Average abandonment term among investigated group of patients was less than a year. The structure of the osteomyelitis process localization in 78 primary patients (100.0 %) indicates a primary lesion of the mandible in 44 patients ( 56.4 %), upper jaw was struck in 23 patients (29.5% ) , both jaws - in 11 people ( 14.1%). On examination, patients with toxic osteomyelitis of jaws were presented with following clinical features: recession of the oral mucosa in the site of lesions of bone destruction, necrotized bone exposure in the oral cavity, odor from the mouth, fistulas on skin, involvement of maxillary sinuses. Radiological findings differentiated from well-defined bone destruction margins to diffused bone destruction lesions without clear borders with a healthy bone structures. Obtained clinical and radiological data served as a background for clinically-radiological toxic jaws osteomyelitis courses classification. According to which, all the patients were divided into 3 types of bone destruction: sequestered, lytic and multifocal lytic. Last one prevailed among patients – it was diagnosed in 64% cases, multifocal lytic type was diagnosed in 14% cases, sequestered – 22% cases. Based on the volume of bone destruction, patients were divided into 4 classes of bone destruction on the lower jaw and 5 classes on the maxilla. Results of investigations were analyzed in correlation with the drug abusing criteria. Among patients with less than a year drug abusing experience, sequestered types of bone destruction prevailed. Group of patients with year to two long experience lytic types of bone destruction were observed two times more often. One of the characteristically signs of the disease were frequent clinical relapses, almost 83,3% cases were hospitalized up to two times a year. Based on these results, we can conclude that the clinical manifestations of toxic facial bone osteomyelitis in patients on a background of drug addiction , including the type of bone destruction , are directly dependent on the duration of use, and avoiding drugs . The conducted investigation allows more accuracy during volumes and terms of surgical treatment planning, as well as relapses prediction.
