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Case Report
Published: 06-01-2023

Acute osteonecrosis of the jaw due to aggravation by the SARS-COV-2 virus: a clinical case report

UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil.
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
FAMECA, Faculty of Medicine of Catanduva - Padre Albino University Center, Catanduva, São Paulo, Brazil / Dental Surgical Clinic, Dr. Dario Ambrizzi, Catanduva, São Paulo, Brazil
UNORTE - University Center of Northern São Paulo, Dentistry department, São José do Rio Preto, São Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, São José do Rio Preto, São Paulo, Brazil
COVID-19 SARS-CoV-2 Osteonecrosis Osteomyelitis Jaw

Abstract

Although many patients recover from COVID-19, it is important to keep in mind that there may be complications after recovery. One such complication in the maxillofacial region is Avascular Necrosis. Viral downregulation of ACE-2 receptors leads to endothelial dysfunction, which together with virus-induced hyperinflammation. Several complications have been observed in the maxillofacial area in people who have suffered from the infection, including osteonecrosis and osteomyelitis of the mandible and maxilla. Osteomyelitis is an inflammatory disease, which occurs in medullary spaces or on bone cortical surfaces, originating due to insufficient blood circulation in the affected region and also by bacteria, fungi, and micro bacteria. In the specific case that will be addressed, the patient suffered a severe worsening of the infection due to micro-thrombi formed by the SARS-CoV-2 virus and severe worsening also due to diabetes mellitus. The treatment is varied, but the most efficient one is the surgical removal of the contaminated bone sequestration, accompanied by broad-spectrum systemic medications. With the combination of clinical history and laboratory tests, the possible cause of maxillary osteonecrosis was the formation of microthrombi resulting from the SARSCoV-2 virus that obliterated the sphenopalatine and descending palatine arteries. The progression and potentization of the infection are favored due to systemic decompensation caused by uncontrolled diabetes.

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References

  1. WHO situation report; WHO Coronavirus disease (COVID-19) situation report. https://CoVid19.who.int. 2022. accessed april 18, 2023.
  2. Dar-Odeh N, Bobamuratova DT, Alnazzawi A, Babkair H, Jambi S, AbuHammad A, Abu-Hammad O. Jaw-related complications in COVID-19 patients; a systematic review. Cranio. 2022 Jan 27:1-8. doi: 10.1080/08869634.2022.2031438.
  3. Petrescu N, Lucaciu O, Roman A. Oral mucosa lesions in COVID-19. Oral Dis. 2020 doi: 10.1111/odi.13499.
  4. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID19. Lancet. 2020;395:1417–1418. doi: 10.1016/S0140-6736(20)30937-5.
  5. Yamaoka-Tojo M. Endothelial glycocalyx damage as a systemic inflammatory microvascular endotheliopathy in COVID-19. Biomed J. 2020;43:399–413. doi: 10.1016/j.bj.2020.08.007.
  6. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020;14:185–192. doi: 10.1007/s11684-020-0754-0.
  7. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, Li T, Chen Q. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;24(12):1–5. doi: 10.1038/s41368-020-0074-x.
  8. Slavkova N, Nedevska M. Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment. Radiol Case Rep. 2022 Jul 2;17(9):3228- 3232. doi: 10.1016/j.radcr.2022.06.009.
  9. Tang C, Wang Y, Lv H, Guan Z, Gu J. Caution against corticosteroid-based COVID-19 treatment. Lancet. 2020;395:1759–1760. doi: 10.1016/S0140- 6736(20)30749-2.
  10. Bennardo F, Buffone C, Giudice A. New therapeutic opportunities for COVID19 patients with tocilizumab: possible correlation of interleukin-6 receptor inhibitors with osteonecrosis of the jaws. Oral Oncol. 2020;106:104659. doi: 10.1016/j.oraloncology.2020.104659.
  11. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71:2459–2468. doi: 10.1093/cid/ciaa530.
  12. Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020;185:599–606. doi: 10.1007/s11046-020-00462-9.
  13. Pauli MA, Pereira LM, Monteiro ML, de Camargo AR, Rabelo GD. Painful palatal lesion in a patient with COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131:620–625. doi: 10.1016/j.oooo.2021.03.010.
  14. Dos Santos JA, Normando AGC, Carvalho da Silva RLC, De Paula RM, Cembranel AC, Santos-Silva AL, Guerra ENS. Oral mucosal lesions in a COVID19 patient: new signs or secondary manifestations? Int J Infect Dis. 2020;97:326– 328. doi: 10.1016/j.ijid.2020.06.012.
  15. Dos Santos JA, Normando AGC, Carvalho da Silva RL, Acevedo AC, De Luca CG, Sugaya N, et al. Oral manifestations in patients with COVID-19: a living systematic review. J Dent Res. 2021;100:141–154. doi: 10.1177/0022034520957289.
  16. Al-Mahalawy H, El-Mahallawy Y, Dessoky NY, Ibrahim S, Amer H, Ayad HM, El Sherif HM, Shabaan AA. Post-COVID-19 related osteonecrosis of the jaw (PCRONJ): an alarming morbidity in COVID-19 surviving patients. BMC Infect Dis. 2022 Jun 14;22(1):544. doi: 10.1186/s12879-022-07518-9.
  17. Boymuradov S, Rustamova DA, Bobamuratova DT, Kurbanov YX, Karimberdiyev BI, et al. Complications of COVID-19 in the maxillo-facial region: Clinical case and review of the literature. Adv in Oral and Maxillofac Surg. 2021;3:100091. doi: 10.1016/j.adoms.2021.100091.
  18. Mañón VA, Balandran S, Young S, Wong M, Melville JC. COVID-Associated Avascular Necrosis of the Maxilla-A Rare, New Side Effect of COVID-19. J Oral Maxillofac Surg. 2022 Jul;80(7):1254-1259. doi: 10.1016/j.joms.2022.04.015.

How to Cite

Riva, G. A., Oliveira, C. E. L. de, Zocarato, P. G. T., Ambrizzi, D. R., & Kassis, E. N. (2023). Acute osteonecrosis of the jaw due to aggravation by the SARS-COV-2 virus: a clinical case report. MedNEXT Journal of Medical and Health Sciences, 4(2). https://doi.org/10.54448/mdnt23216