Open Access

Table I

Studies included in the literature review.

Authors Title Article type Objective Materials and methods Results Conclusion
Poghosyan et al. [5] Surgical treatment of jaw osteonecrosis in “Krokodil” drug addicted patients Retrospective study To propose a therapeutic management of maxillo-mandibular osteonecrosis induced by krokodil n = 40 patients (M = 39, F = 1)
age = 41 ± 1 year
11 maxillary necroses, 21 mandibular necroses, 8 maxillomandibular necroses
Protocol put in place:
1 − Addiction weaning
2 − Necrosectomies with 0.5 cm margins associated with local flap closure
– 100% (n = 11) of success of maxillary necrosectomies
– 23% (n = 8) of recurrence in mandibular necrosectomies
– 38% (n = 8) of oral-sinus communications after maxillary surgery
According to this study, surgery combined with drug withdrawal is the treatment of choice for krokodil-induced necrosis.
Hakobyan et al. [6] The use of oral adipose tissue in "Krokodil" drug-related osteonecrosis of the maxilla Retrospective study Describe the value of reconstructing substance losses associated with krokodil-induced MON surgeries n = 6 patients (M = 6, F = 0)
age = 42.7 +/− 2.4 years
Stage 3 Maxillary Necrosis (AAOMS)
After 1 month of weaning, excision of the necrotic tissue and closure of the sinus fundus using flaps made from adipose tissue from the cheek and mucoperiosteal local flaps.
– 100% (n = 6) of first-line closure without postoperative complication Radical debridement of necrotic bone associated with partial sinusotomy and transposition of an adipose fat flap of the cheek can be used as an effective and predictable means of treating posterior maxillary osteonecrosis induced by krokodil
Hakobyan and Poghosyan[8] Spontaneous bone formation after mandible segmental resection in “Krokodil” drug-related jaw osteonecrosis patient: case report Case report. Presentation of a necrosectomy case study 48-year-old patient with maxillo-mandibular osteonecrosis induced by taking krokodil for 1.5 years, weaned for 8 months. Performing a maxillary sequestrectomy and a partial resection of the mandible without reconstruction. Postoperative follow-up over three years shows bone neo-formation in place of mandibular resection. Spontaneous bone formation is possible after segmental mandibular resection in a patient with weaned osteonecrosis.
Hakobyan et al. [9] C-Terminal Telopeptide Level in “Krokodil” Drug-Related Jaw Osteonecrosis Patients. Retrospective study To determine whether there is a relationship between serum CTX and sequestration in patients with krokodil-induced MONs n = 17 patients (M = 17, F = 0)
age 40.65 ± 2.1 years
Patients weaned for 5.1 ± 1 month (1 to 15 months)
Divided into two groups:
- Group 1: n = 9 patients without evidence of sequestration
–Group 2: n = 8 patients with osteonecrosis with sequestration
Group 1 showed low CTX levels illustrating the inhibition of turnover induced by the krokodil anti-resorption effect.
Group 2 showed significantly higher CTX levels with a positive correlation between CTX level and the presence of a sequestrum.
According to this study, a high level of CTX would indicate increased bone turnover. This would allow the creation of a demarcation zone and the formation of a sequestrum.
Hakobyan and Poghosyan [7] Spontaneous Closure of Bilateral Oro-Antral Communication Formed After Maxillary Partial Resection in “Krokodil” Drug-related Jaw Osteonecrosis Patient: Case Report. Case report. Presentation of a necrosectomy case study 40-year-old patient with maxillary osteonecrosis induced by krokodil for 1.5 years, weaned for 5 months. Performing resection of the necrotic bone with margins at 0.5 cm affecting all the alveolar processes, the hard palate, the sinus and the floor of the nasal fossae. Oral-nasal and oral-sinus communication could not be closed without tension. Postoperative control at 2 months shows bilateral spontaneous closure of naso and bucco-sinus communication. Spontaneous cicatrization of postoperative oral-antral communication is possible despite the absence of first-line closure in a weaned patient.

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