Ekaterinburg, Ekaterinburg, Russian Federation
Yekaterinburg, Ekaterinburg, Russian Federation
Ekaterinburg, Ekaterinburg, Russian Federation
The research is relevant due to the widespread use of osteomodifying agents among patients with bone metastases with malignant neoplasms of various localization. The healing process is sluggish due to the toxic effect of these medications, including their influence on soft tissues; it often occurs that relapse sets in after surgical treatment. The research aims to study possible variants and degree of mucosa microcirculation disorders of the alveolar processes among patients with drug-associated osteonecrosis of the jaw. Materials and methods of the research. Microcirculation was examined with the method of Laser Doppler flowmetry (LDF) with the LAKK-OP analyzer (modification 1) (SPE “LAZMA” Ltd, Moscow). The patients diagnosed with drug-associated osteonecrosis of the jaw were examined for microcirculation by Laser Doppler flowmetry method in the lesion and at the side with no visible clinical manifestations. The exclusion criterion was the patient’s general medical condition with the score no less than three on the EGOC scaling. The comparison group included practically healthy volunteers. The exclusion criteria were complete secondary adentia, heart defects, hypertension, vascular pathology, diabetes mellitus, cancer, bronchial asthma, chronic obstructive pulmonary disease, maxillofacial inflammatory diseases, HIV infection. Results. The perfusion index among the patients with drug-associated osteonecrosis of the jaw was lower by 0.65 pf. units (17,53 ± 4,04 pf. units) in the lesion and by 2,14 pf. units (16,14 ± 3,23 pf. units) at the side with no visible clinical manifestation compared to the healthy group (18,18 ± 6,24 pf. units). The average amplitude of myogenic oscillations in the main group (3,24 ± 2,08 pf. units) was higher than the oscillation indices of different origin; on the contrary, in the comparison group, as well as in the healthy part of the main group, the amplitude of neurogenic oscillations prevailed (1,64 ± 0,91 pf. units and 3,41 ± 1,53 pf. units). Conclusion. The research reveals impaired microcirculation symptoms of the ischemic-stagnant type, both in the lesion and at the side with no visible clinical manifestations, which indicates a system failure of the mucous membrane of alveolar processes among these patients.
osteonecrosis of the jaw, microcirculation, Laser Doppler Flowmetry, mucous membrane of alveolar, perfusion
1. 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.)]. DOI:https://doi.org/10.26787/nydha-2226-7425-2018-20-5-88-92.
2. Ebzeev A.K. Bisfosfonatnyy osteonekroz chelyustey u onkologicheskih pacientov. Kazanskiy med. zh. 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
3. Ruggiero S., Saxena D., Tetradis S., Aghaloo T., Ioannidou E. Task force on design and analysis in oral health research: Medication related osteonecrosis of the jaw // JDR Clinical & Translational Research. - 2018;3(3):222-225. DOI:https://doi.org/10.1177/2380084418770662.
4. Lina He, Xiangyu Sun, Zhijie Liu, Yanfen Qiu, Yumei Niu. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw // International Journal of Oral Science. - 2020;12-30. DOI:https://doi.org/10.1038/s41368-020-00093-2
5. Tara Aghaloo, Renna Hazboun, Sotirios Tetradis. 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.
6. Anesi A., Generali L., Sandoni L., Pozzi S., Grande A. From Osteoclast Differentiation to Osteonecrosis of the Jaw: Molecular and Clinical Insights Int // J Mol Sci. - 2019;20(19):4925. DOIhttps://doi.org/10.3390/ijms20194925.
7. Ivanyushko T.P., Polyakov K.A., Medvedev Yu.A., Shamanaev S.V., Trofimov D.Yu., Abramov D.D., Balykin R.A. Issledovanie uslovno-patogennyh mikroorganizmov u bol'nyh s bisfosfonatnym osteonekrozom chelyustey. Stomatologiya. 2016;95(1):44-48. [T.P. Ivanyushko, K.A. Polyakov, Yu.A. Medvedev, S.V. Shamanaev, D.Yu. Trofimov, D.D. Abramov, R.A. Balyikin. Conditionally pathogenic microorganisms in patients with bisphosphonate jaw osteonecrosis. Dentistry. 2016;95(1):44-48. (In Russ.)]. DOI:https://doi.org/10.17116/stomat201695144-48.
8. 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. DOI:https://doi.org/10.1002/cre2.303.
9. Romero-Ruiz M.M., Romero-Serrano M., Serrano-González A., Serrera-Figallo M.Á., Gutiérrez-Pérez J.L., Torres-Lagares D. Proposal for a preventive protocol for medication-related osteonecrosis of the jaw // Med Oral Patol Oral Cir Bucal. - 2021;1;26(3):e314-326. doi:https://doi.org/10.4317/medoral.24197.
10. Vinogradova N.G., L'vov K.V., Haritonova M.P., Zhirnov A.V. Primenenie autologichnoy plazmy pri lechenii medikamentozno-associirovannogo 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.)]. DOI:https://doi.org/10.18481/2077-7566-2019-15-4-103-108.
11. 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. DOI:https://doi.org/10.5125/jkaoms.2019.45.2.108.
12. Ivanov A.N., Kozadaev M.N., Puchin'yan D.M., Sal'kovskiy Yu.E., Norkin I.A. Izmeneniya mikrocirkulyacii pri stimulyacii regeneracii tkaney skaffoldom na osnove polikaprolaktona. Regionarnoe krovoobraschenie i mikrocirkulyaciya. 2015;14(2):70-75. [A.N. Ivanov, M.N. Kozadaev, D.M. Puchin'yan, Yu.E. Sal'kovskii, I.A. Norkin. Microcirculatory changes during stimulation of tissue regeneration by polycaprolactone scaffold. Regional blood circulation and microcirculation. 2015;14(2):70-75. (In Russ.)]. DOI:https://doi.org/10.24884/1682-6655-2015-14-2-70-75.
13. Barhatov I.V. Primenenie lazernoy dopplerovskoy floumetrii dlya ocenki narusheniy sistemy mikrocirkulyacii krovi cheloveka. Kazanskiy medicinskiy zhurnal. 2014;95(1):63-69. [I.V. Barhatov. Laser doppler flowmetry for human blood microcirculation assessment. Kazan medical journal. 2014;95(1):63-69. (In Russ.)]. DOI:https://doi.org/10.17816/KMJ1458.
14. Vinogradova N.G., Haritonova M.P., L'vov K.V. Lazernaya doplerovskaya floumetriya - metod opredeleniya granic sekvestrektomii pri bisfosfonatnom osteonekroze chelyusti. Ural'skiy medicinskiy zhurnal. 2019;2(170):101-105. [N.G. Vinogradova, K.V. Lvov, M.P. Kharitonova. Laser doppler flowmetry as the method of sequestrectomy determinator lines with bisphosphonate osteonecrosis of the jaw. Ural medical journal. 2019;2(170):101-105. (In Russ.)]. DOI:https://doi.org/10.25694/URMJ.2019.02.33
15. Klinicheskie rekomendacii po primeneniyu osteomodificiruyuschih agentov u pacientov s metastazami v kosti zlokachestvennyh opuholey. Kollektiv avtorov. Associaciya onkologov Rossii. Moskva. 2014:6. [Clinical recommendations for the use of osteomodifying agents in patients with bone metastases of malignant tumors. Team of authors. Oncologists association in Russia. Moscow. 2014:6. (In Russ.)]. http://oncology.ru/association/clinical-guidelines/2014/30.pdf
16. Klinicheskie rekomendacii: Rak molochnoy zhelezy. Kollektiv avtorov. Associaciya onkologov Rossii. Moskva. 2020:123. [Clinical recommendations: Breast cancer. Team of authors. Oncologists association in Russia. Moscow. 2020:123. (In Russ.)]. http://oncology.ru/specialist/treatment/references/actual/379.pdf
17. Klinicheskie rekomendacii: Rak predstatel'noy zhelezy. Kollektiv avtorov. Associaciya onkologov Rossii. Moskva. 2020:140. [Clinical recommendations: Prostate cancer. Team of authors. Oncologists association in Russia. Moscow. 2020:140. (In Russ.)]. http://oncology.ru/association/clinical-guidelines/2018/rak_predstatelnoy_zhelezy_pr2018.pdf
18. Klinicheskie rekomendacii: Zlokachestvennye novoobrazovaniya bronhov i legkogo. Kollektiv avtorov. Associaciya onkologov Rossii. Moskva. 2020:190. [Clinical recommendations: Malignant neoplasms of the bronchi and lung. Team of authors. Oncologists association in Russia. Moscow. 2020:190. (In Russ.)]. https://oncology-association.ru/wp-content/uploads/2021/02/rak-legkogo-2021.pdf
19. Klinicheskie rekomendacii: Mnozhestvennaya mieloma. Kollektiv avtorov. Associaciya onkologov Rossii. 178 s. Moskva. 2020. [Clinical recommendations: Multiple myeloma. Team of authors. Oncologists association in Russia. 178 p. Moscow. 2020. (In Russ.)]
20. Klinicheskie rekomendacii: Rak parenhimy pochki. Kollektiv avtorov. Associaciya onkologov Rossii. Moskva. 2020:105. [Clinical recommendations: Kidney parenchyma cancer. Team of authors. Oncologists association in Russia. Moscow. 2020:105. (In Russ.)]. http://oncology.ru/association/clinical-guidelines/2018/rak_pochki_pr2018.pdf
21. Ruggiero S.L., Dodson T.B., Fantasia J., Goodday R., Mehrotra B. et al. 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.
22. Krupatkin A.I. Kolebaniya krovotoka - novyy diagnosticheskiy yazyk v issledovanii mikrocirkulyacii. Regionarnoe krovoobraschenie i mikrocirkulyaciya. 2014;13(1):83-99. [A.I. Krupatkin. Blood flow oscillations - new diagnostic language in microvascular research. Regional blood circulation and microcirculation. 2014;13(1):83-99. (In Russ.)]. DOI:https://doi.org/10.24884/1682-6655-2014-13-1-83-99.
23. Kozlov V.I., Azizov G.A., Gurova O.A., Litvin B.F. Lazernaya dopplerovskaya floumetriya v ocenke sostoyaniya i rasstroystv mikrocirkulyacii krovi. Metodicheskoe posobie dlya vrachey. Moskva. 2012:32. [V.I. Kozlov, G.A. Azizov, O.A. Gurova, B.F. Litvin. Laser Doppler flowmetry in the assessment of microcirculatory disorders and blood. Handbook for doctors. Moscow. 2012:32. (In Russ.)]. http://angiologia.ru/specialist/cathedra/recommendations/2012/001.pdf
24. Cymbalistov V.A., Statovskaya E.E., Sosnina Yu.S. Osobennosti mikrocirkulyacii tkaney parodonta bol'nyh vegetativno-sosudistoy distoniey. Institut stomatologii. 2010;4(49):68-69. [A.V. Tsimbalistov, E.E. Statovskaya, Yu.S. Sosnina. Microcirculation features of periodontics in patients with dystonia. Institute of dentistry. 2010;4(49):68-69. (In Russ.)]. https://www.elibrary.ru/item.asp?id=15542039
