TACTICAL APPROACHES TO SOLVING THE PROBLEM IN THE TREATMENT OF OSTEOMYELITIS OF THE MAXILLARY IN PATIENTS WHO HAVE BREAST CANCER AND ARE TAKING BISPHOSPHONATES (CLINICAL CASE)
DOI:
https://doi.org/10.35220/2078-8916-2024-51-1.11Keywords:
bisphosphonates, chronic osteomyelitis of the jaws, subantimicrobial doses.Abstract
Problem statement. The problem of the growth of malignant processes of various localization is one of the most important issues of healthcare in Ukraine. Its relevance is determined not only by the spread of oncological processes among the population, but also by the severity of timely diagnosis, high cost and complexity of treatment, high level of disability and mortality of patients. The aim of the study. Determining the features of the clinical picture of osteomyelitis in a patient with breast cancer, the treatment regimen of which includes Zoledronic acid, and the development of tactics for the treatment of dental disease. Research methods. Patient X., born in 1966, with complaints about the lack of healing of the hole after the removal of a tooth on the upper right jaw and constant pain in this area. The patient has been in dispensary registration since 2020 due to Cr of the right mammary gland T2N1M0, clinical group 2. She was examined according to the standard protocol, with a cone-beam computed tomography of the upper jaw. Treatment was carried out using a subantimicrobial dose of doxycycline (SDD). Research results. The effectiveness of the treatment was evaluated by finding out the degree of complaints, objective examination and X-ray examination. Examination after 10 days ‒ complaints of discomfort in the area of the socket of tooth 16, hyperemia of the mucous membrane in the area of the socket, sensitivity during palpation in this area remains. Follow-up examination after 3 months ‒ there are no complaints, the complete healing of the tooth cavity is noted. There are no pathological changes on OTPG. Conclusions. The described clinical example demonstrates that the treatment of chronic inflammatory diseases of the maxillofacial region in patients taking bisphosphonates by systemic use of doxycycline in subantimicrobial doses has a pronounced anti-inflammatory effect and can be recommended for use in the outpatient practice of a dental surgeon in the rehabilitation of this category of patients.
References
Інструкція для медичного застосування лікарського засобу Золедронова кислота (ZOLEDRONIC ACID) режим доступу https://likicontrol.com.ua
Ремез О.І., Костенко Є.Я. Проблеми профілактики остеонекрозу щелеп при лікуванні метастатичної хвороби кісток бісфосфонатами. Науковий вісник Ужгородського університету, Серія «Медицина», 2011. № 40, С. 34-37.
Патент на корисну модель № 143458 Україна, МПК A61K 39/39 (2006.01) A61P 1/02 (2006.01). Спосіб комбінованого лікування хронічного остеомієліту щелеп в осіб молодого віку з вродженим остеопенічним синдромом / О. Ю. Стоян, О. Г. Денисова, І. І. Соколова, М. М. Бірюкова (UA). – № u 2020 01762 ; заявл. 13.03.2020 ; опубл. 27.07.2020, Бюл. № 14. Режим доступу: https://repo.knmu.edu.ua/ handle/123456789/27248
Barza M., Brown R.B., Shanks C., Gamble Ch., Relation L. W., Lipophilicity B. Pharmacological Behavior of Minocycline, Doxycycline, Tetracycline, and Oxytetracycline in Dogs. Antimicrob Agents Chemother. 1975, № 8(6). Р. 713–720 doi: 10.1128/AAC.8.6.713.
Golub L.M., Lee H.-M., Stoner J.A., Reinhardt R.A. et al Doxycycline Effects on Serum Bone Biomarkers in Post-menopausal Women. J Dent Res. 2010. № 89 (6). Р. 644 – 649 doi: 10.1177/0022034510363367
Dreno В., Bettoli V, Ochsendorf F, Layton A. et al European Recommendation on the Oral Antibiotics for Acne. Eur, J. Dermatol. 2004. № 14. Р. 391- 399.
Migliorati C., Siegel M., Elting L. Bisphosphonateassociated osteonecrosis: a long‒term complication of bisphosphonate treatment. Lancet. 2006.V. 7. P. 508-514.
Migliorati C.A. Bisphosphanates and oral cavity avascular bone necrosis. J. Clin. Oncol. 2003. V. 21. P.253-254.
Migliorati C., Siegel M., Elting L. Bisphosphonateassociated osteonecrosis: a long‒term complication of bisphosphonate treatment. Lancet. 2006. V. 7. P. 508-514.
Migliorati C.A. Bisphosphanates and oral cavity avascular bone necrosis. J. Clin. Oncol. 2003. V. 21. P.253-254.
Ficarra G., Beninati F., Rubino I. et al. Osteonecrosis of the jaws in periodontal patients with a history of bisphosphonates treatment. J. Clin. Periodontol. 2005. V. 32. P.1123-1128.
Mehrotra B., Fantasia J., Nissel-Horowitz S. et al. Osteonecrosis of the maxilla: an unusual complication of prolonged bisphosphonate therapy a case report. Proc. Am. Soc. Clin. Oncol. 2006. V. 22. Р. 795.
Santini D., Vincenzi B., Avvisati G. et al Pamidronate induces modifications of circulating angiogenic factors in cancer patients. Clin Cancer Res. 2002. V. 8. P. 1080-1084.
Paterson A. I. The Role of Bisphosphonates in Early Breast Cancer. The Oncologist. 2006. V. 11. P. 13-19.
Pogrel M.A., Miller C. E. A case of maxillary necrosis. J. Oral Maxillofac Surg. 2003. V. 61. P.489-493.
Preshaw P.M., Hefti A.F., Jepsen S., Etienne D., Walker C., Bradshaw M.H. Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. A review. J Clinical Periodontology. 2004. № 31. Р. 697–707
Sapadin A.N., Fleischmajer R. Tetracyclines: Nonantibiotic Properties and their Clinical Implications. J. Am. Acad. Dermatol. 2006. № 54. Р. 258 -265.
