Ekaterinburg, Ekaterinburg, Russian Federation
Yekaterinburg, Ekaterinburg, Russian Federation
Ekaterinburg, Ekaterinburg, Russian Federation
Object of research. Drug-associated osteonecrosis of the jaw is a complication of therapy with osteo-modifying agents. Several theories of its pathogenesis have been deduced, but there is no uniform treatment plan that would reduce the risk of relapse and allow timely prevention. The research aims to demonstrate the effectiveness of the intraoperative use of a diode laser in the treatment of drug-associated osteonecrosis of the jaw. Methodology. The article presents the case of treatment of 60-year-old patient with drug-associated osteonecrosis of the jaw. The underlying medical condition is Bence-Jones myeloma, Stage III on the Durie-Salmone Staging System, with the Th1 – Th12, L1 – L5 involvement. A laser surgical device with a diode laser with a wavelength of 980 nm, power of 0.1-20 W, with a continuous pulse type was used intraoperatively for ablation of residual granulations. An APRF clot was placed at the bottom of the wound. On the 5th and 10th days, autologous plasma injections were performed in the area of surgical treatment. Results. Low pain syndrome during the postoperative period, immediate agglutination, no relapse a month after surgery, closure of the cortical plates according to the control CT scan results. Conclusion. Thus, the first case of clinical use of a diode laser in the treatment of drug-associated osteonecrosis of the jaw has demonstrated its effectiveness. It cannot completely replace the traditional methods, but diode laser is an important auxiliary instrument which contributes to the rehabilitation of the focus of infection, stimulates reparative processes both in the mucous membrane and in the bone. Its future application in the treatment of drug-associated osteonecrosis of the jaw is promising and might prove its effectiveness in reducing the frequency of relapses.
drug-associated osteonecrosis of the jaw, diode laser, osteomyelitis, osteomodifying agents, chemotherapy
1. Ebzeev A.K. Bisfosfonatnyy osteonekroz chelyustey u onkologicheskih pacientov. Kazanskiy medicinskiy zhurnal. 2020;101;2:226-231. [A.K. Ebzeev. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) in cancer patients. Kazan medical journal. 2020;101;2:226-231. (In Russ.)]. doi:https://doi.org/10.17816/KMJ2020-226
2. Ruggiero S.L., Dodson T.B., Fantasia J., Goodday R., Mehrotra B. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw // J. Oral Maxillofac. Surg. - 2014;72:1938-1956. DOI:https://doi.org/10.1016/j.joms.2014.04.031.
3. Kollektiv avtorov. Klinicheskie rekomendacii po primeneniyu osteomodificiruyuschih agentov u pacientov s metastazami v kosti zlokachestvennyh opuholey. Associaciya onkologov Rossii. Moskva. 2014:6. [Team of authors. Clinical recommendations for the use of osteomodifying agents in patients with bone metastases of malignant tumors. Oncologists association in Russia. Moscow. 2014:6. (In Russ.)].
4. Zhuravleva M.V., Zhuravlev L.V., Firsova I.V. Sovremennyy vzglyad na problemu bisfosfonatnogo osteonekroza chelyustey (obzornaya stat'ya). Zdorov'e i obra-zovanie v XXI veke. 2018;20(5):88-92. [M.V. Zhuravleva, L.V. Zhuravlev, I.V. Firsova. Actual view on the problem of bisphosphonate related jaw osteonecrosis. Health and education in the XXI century. 2018;20(5):88-92. (In Russ.)]. DOIhttps://doi.org/10.26787/nydha-2226-7425-2018-20-5-88-92.
5. Lina He, Xiangyu Sun, Zhijie Liu, Yanfen Qiu and Yumei Niu. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw // International Journal of Oral Science. - 2020;12:30. https://doi.org/10.1038/s41368-020-00093-2
6. Tara Aghaloo, Renna Hazboun, and SotiriosTetradis. Pathophysiology of Osteonecrosis of the Jaws // Oral MaxillofacSurgClin North Am. - 2015;27(4):489-496. doi:https://doi.org/10.1016/j.coms.2015.06.001. Epub 2015 Sep 26.
7. Şahin O., Odabaşı O., Aliyev T., Tatar B. Risk factors of medication-related osteonecrosis of the jaw: a retrospective study in a Turkish subpopulation // J Korean Assoc Oral Maxillofac Surg. - 2019;45:108-115. doihttps://doi.org/10.5125/jkaoms.2019.45.2.108.
8. Vinogradova N.G., L'vov K.V., Haritonova M.P., Zhirnov A.V. Primenenie autologichnoy plazmy pri lechenii medikamentoznoassociirovnnogo osteonekroza chelyusti. Problemy stomatologii 2019;15(4):103-108. [N.G. Vinogradova, K.V. Lvov, M.P. Kharitonova, A.V. Zhirnov. Application of autologous plasma in the treatment of medication-related osteonecrosis of the jaw. Actual problems in dentistry. 2019;15(4):103-108. (In Russ.)]. DOIhttps://doi.org/10.18481/2077-7566-2019-15-4-103-108
9. Albanese M., Zotti F., Capocasale G., Bonetti S., Lonardi F., Nocini P.F. Conservative non-surgical management in medication related osteonecrosis of the jaw: A retrospective study // Clin Exp Dent Res. - 2020;6:512-518. https://doi.org/10.1002/cre2.303
10. Belikov A.V., Ermolaeva L.A., Korzhevskiy D.E., Sergeeva E.S., Semyashkina Yu.V., Antropova M.M., Fedotov D.Yu., Soldatov I.K. Issledovanie regeneracii slizistoy obolochki polosti rta posle frakcionnogo diodnogo lazernogo vozdeystviya s dlinoy volny 980 nm. Nauchno-tehnicheskiy vestnik informacionnyh tehnologiy, mehaniki i optiki. 2018;18;5:719-726. [A.V. Belikov, L.A. Ermolaeva, D.E. Korzhevsky, E.S. Sergeeva, Yu.V. Semyashkina, M.M. Antropova, D.Yu. Fedotov, I.K. Soldatov. Investigation of the regeneration of the oral mucosa after fractional diode laser exposure with a wavelength of 980 nm. Scientific and technical bulletin of information technologies, mechanics and optics. 2018;18;5:719-726. (In Russ.)]. Doihttps://doi.org/10.17586/2226-1494-2018-18-5-719-726
11. Dong X., Shen L.H., Yi Z., He L.H., Yi Z. Case reports of medication-related osteonecrosis of the jaw (MRONJ) treated with uncultured stromal vascular fraction and L-PRF // Med Sci Monit. - 2021;10;27:e929684. doi:https://doi.org/10.12659/MSM.929684.
12. Giudice A., Antonelli A., Chiarella E., Baudi F., Barni T., Di Vito A. Case reports of medication-related osteonecrosis of the jaw (MRONJ) treated with uncultured stromal vascular fraction and L-PRF // Pharmaceuticals (Basel). - 2020;25;13(12):423. doi:https://doi.org/10.3390/ph13120423.
13. Privalov V.A., Krochek I.V., Lappa A.V. Osteoperforaciya diodnym lazerom v lechenii ostrogo i hronicheskogo osteomielita. Byull. VSNC SO RAMN. 2001;3(17);1:115-121. [V.A. Privalov, I.V. Krochek, A.V. Lappa. Osteoperforation with a diode laser in the treatment of acute and chronic osteomyelitis. Bull. VSNTs SO RAMN-2001;3(17);1:115-121. (In Russ.)].
14. Baybekov I.M., Rahmanov H.Sh., Irhanov M.M. Antimikrobnyy i protivovospalitel'nyy effekt lazernogo izlucheniya i Holisala pri ih kompleksnom ispol'zovanii v lechenii proteznyh stomatitov. Lazernaya medicina. 2020;24(2-3):29-36. [I.M. Baybekov, Kh.Sh. Rakhmanov, M.M. Irkhanov. Antimicrobial and anti-inflammatory effect of laser radiation and Cholisal in their complex use in the treatment of prosthetic stomatitis. Laser Medicine. 2020;24(2-3):29-36. (In Russ.)]. Doihttps://doi.org/10.37895/2071-8004-2020-24-2-3-29-36
15. Privalov V.A., Krochek I.V., Lappa A.V. Osteoperforaciya diodnym lazerom v lechenii ostrogo i hronicheskogo osteomielita. Byull. VSNC SO RAMN. 2001;3(17);1:115-121. [V.A. Privalov, I.V. Krochek, A.V. Lappa. Osteoperforation with a diode laser in the treatment of acute and chronic osteomyelitis. Byull. VSNTs SO RAMN. 2001;3(17);1:115-121. (In Russ.)].