The use of buccal fat pad in surgical treatment of ‘Krokodil’ drug-related osteonecrosis of maxilla

Hakobyan, Koryun; Poghosyan, Yuri; Kasyan, Aram

doi:10.1016/j.jcms.2018.03.007

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Its pharmacokinetic characteristics, including increased lipophilicity, faster onset of action and shorter half‐life compared to morphine, are thought to be responsible for its addictive and reinforcement properties . The homemade production of desomorphine by the combination of codeine‐containing products (analgesic or antitussive preparations) and other readily available ingredients such as iodine, soda, red phosphorus, gasoline and hydrochloric acid produces an injectable liquid. The route of administration is usually by either intramuscular or intravenous injection, making the user susceptible to the harmful effects of the other components .…”

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

“…Recent literature has shown that the active ingredient and diluents have an antiresorptive effect and result in a high incidence of osteonecrosis of the jaw (ONJ), with maxilla involvement only in 27.5%, the mandible only in 52.5% and both jaws affected in 20% of patients . In the vast majority of cases (92.3%), tooth removal was the trigger for the development of ONJ, where bone exposure can occur up to 12 months after the extraction . In addition to exposed bone, other reported clinical signs included swelling of the adjacent oral mucosa, intra‐ and extra‐oral fistulas in the surrounding area, together with associated pain .…”

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

“…In addition to exposed bone, other reported clinical signs included swelling of the adjacent oral mucosa, intra‐ and extra‐oral fistulas in the surrounding area, together with associated pain . Other reported risk factors for ONJ in users include poor‐quality dentures, failed endodontic treatment, periodontitis, acute and chronic trauma of the oral cavity and poor oral hygiene . Surgery is currently the predominant method of treatment …”

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

“…Other reported risk factors for ONJ in users include poor‐quality dentures, failed endodontic treatment, periodontitis, acute and chronic trauma of the oral cavity and poor oral hygiene . Surgery is currently the predominant method of treatment …”

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

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Oral manifestations of illicit drug use

Teoh

Moses

McCullough

2019

Australian Dental Journal

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The use of illicit and misuse of licit drugs is a global public health problem, with illicit drug use being responsible for 1.8% of the total disease burden in Australia in 2011. Oral adverse effects associated with illicit drug use are well-established, with aggressive caries, periodontitis, bruxism, poor oral hygiene and general neglect documented. Other factors such as a high cariogenic diet and lifestyle, social and psychological factors compound the poorer oral health in illicit drug users. Literature has shown that the oral health-related quality of life among injecting drug users is poorer compared with the Australian general population and the overall quality of life of addicted people correlates with caries experience. Thus, the role of the dentist is imperative in managing the oral health of these individuals. Given their widespread recreational use, it is likely that dental practitioners will encounter patients who are regular or past users of illicit drugs. The aim of this article is to describe the prevalence and mechanism of action of commonly used illicit drugs in Australia, including cannabis, methamphetamine, cocaine and heroin and to inform dentists about the common orofacial presentations of their side effects to help with patient management.Abbreviations and acronyms: CBD = cannabidiol; CNS = central nervous system; MA = methamphetamine; ONJ = osteonecrosis of the jaw; THC = delta-9 tetrahydrocannabinol.

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Section: Opioids – Heroin and Methadonementioning

confidence: 99%

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

Section: Opioids – Heroin and Methadonementioning

confidence: 99%

See 2 more Smart Citations

Oral manifestations of illicit drug use

Teoh

Moses

McCullough

2019

Australian Dental Journal

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“…A recurrence of necrosis in the mandible was observed in 23% of cases, but no maxillary recurrence was described in the literature [5]. In these patients, the management of oral-sinus communication following maxillary necrosectomies with adipose tissue flaps seemed to have good results, but a case of spontaneous closure was also described [6,7]. Hakobyan et al described spontaneous bone neoformation following a segmental mandibulectomy without bone reconstruction in a former drug addict [8].…”

Section: Discussionmentioning

confidence: 99%

Krokodil (Desomorphine)-induced osteonecrosis of the maxilla: a case report and literature review

Sergent

Bader

Hamon

et al. 2019

J Oral Med Oral Surg

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Introduction: Desomorphine is an opioid formerly used to treat acute pain. It is simple to manufacture, which has recently led to an increase in its clandestine production under the name “Krokodil”. This article presents a case of oral problems related to its use first ever reported in France. Observation: A 36-year-old male patient presented with bone exposure in sector 1. He admitted to actively consuming “Krokodil IV” for several years. In the course of the clinical and radiological examinations, the patient was diagnosed with osteochemonecrosis of the maxillary induced by krokodil, considering that severe intrinsic and extrinsic adverse effects have been attributed to the drug. Discussion: A systematic literature review was conducted using articles from the Medline and Web of Science databases. To treat such a condition, two authors have described a process consisting of total excision of the necrotic tissue with 0.5 cm margins, combined with discontinuing the intake of the drug. However, these observations should be considered with caution because of the absence of any prospective studies. Conclusion: There are a number of etiologies for osteonecrosis in the context of radiotherapy, intake of bisphosphonates, and administration of bone resorption inhibitors. Unfortunately, in the case of krokodil, its high addictive nature makes it difficult for the patient to wean off the drug. Further, the heterogeneity of its manufacturing make it challenging to pharmacokinetically analyze its prolonged use. In view of the current literature, surgical therapy associated with weaning appears to be the most appropriate treatment, without being able to rule out addiction or necrotic relapses.

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