J Oral Med Oral Surg
Volume 25, Number 3, 2019
|Number of page(s)||6|
|Section||Cas clinique et revue de la littérature / Up-to date review and case report|
|Published online||18 July 2019|
Up-to Date Review And Case Report
Krokodil (Desomorphine)-induced osteonecrosis of the maxilla: a case report and literature review
Oral Surgery Department, CHU Rennes, France
2 Service d'ORL, CHU Rennes, France
* Corresponding author: firstname.lastname@example.org
Accepted: 11 June 2019
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.
Key words: Krokodil / osteonecrosis / maxilla
© The authors, 2019
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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