WIDESPREAD OSTEONECROSIS OF THE UPPER JAW AFTER CORONAVIRUS INFECTION

The pandemic caused by the new coronavirus SARS-CoV-2 is another challenge for humanity. The efforts of scientists and doctors around the world are aimed at studying the features of the epidemiology, pathogenesis, clinic and treatment of the coronavirus infection COVID-2019. Direct interaction of the causative agent of a new coronavirus infection with ACE-2 receptors, which are present both in the alveoli of the lungs, the myocardium, and in the endothelium of blood vessels, leads to damage to the vascular wall, stimulates response thrombus formation. One of the important mechanisms in the pathogenesis of osteonecrosis, including that of the jaw bones, in the occurrence of bone necrosis is a violation of blood circulation, as well as a deterioration in the rheological properties of blood and a slowdown in the rate of volumetric blood flow, which can be the cause of intravascular coagulation. These two factors are the main cause of bone necrosis with the release of inflammatory mediators. Therefore, it can be assumed that damage to the vascular wall and impaired microcirculation in a new coronavirus infection may contribute to the development of a destructive form of osteonecrosis of the jaw bones. We report a case of diffuse destructive osteonecrosis of the maxilla in a 67-year- old female patient suffering from hypertension and type 2 diabetes mellitus after bilateral pneumonia associated with a new coronavirus infection. During the first hospitalization, surgical intervention consisted in the removal of teeth 2.4, 2.5, 2.6, a freely located bone sequester of the alveolar process within the boundaries of teeth 2.4, 2.5, periostectomy within the boundaries of teeth 2.2, 2.3, 2.4, 2.5. There was no bleeding from the sockets of the teeth, the visible bone of the alveolar process was white, bloodless, “naked”. When examined 2 months after the operation, in the oral cavity - exposure of the bone of the alveolar process within the boundaries of 2.1 - 2.6 teeth, when probing from the side of the palate - a pathological pocket extending in the direction of the soft palate to a depth of more than 2.0 cm. Bone sequestration within the boundaries of the alveolar the process containing the sockets of the removed teeth is mobile. A surgical intervention was performed - sequestrectomy, during which a defect was formed that communicates the oral cavity with the nasal cavity on the left and the maxillary sinus. The defect is closed by a protective plate that separates the cavity of the mouth, nose and maxillary sinus.