Poghosyan Yuri M, Hakobyan Koryun A, Poghosyan Anna Yu, Avetisyan Eduard K
Chair of Postgraduate Maxillofacial Surgery of YSMU (Head: Prof. Yuri M. Poghosyan D.Sc.), 2 Koryun Str, Yerevan 0025, Armenia.
Department of Maxillofacial and ENT Surgery (Head: Prof. Anna Yu Poghosyan D.Sc.), "Heratsy" №1 University Hospital, 60 Abovyan Str., Yerevan 0025, Armenia.
J Craniomaxillofac Surg. 2014 Dec;42(8):1639-43. doi: 10.1016/j.jcms.2014.05.005. Epub 2014 May 28.
Retrospective study of jaw osteonecrosis treatment in patients using the "Krokodil" drug from 2009 to 2013. On the territory of the former USSR countries there is widespread use of a self-produced drug called "Krokodil". Codeine containing analgesics ("Sedalgin", "Pentalgin" etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use "Krokodil". The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". 40 "Krokodil" drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of "Krokodil" use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla. According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". Cessation of drug use and jaw resection minimize the rate of recurrences in such patients.
2009年至2013年使用“克洛克代尔”药物的患者颌骨骨坏死治疗的回顾性研究。在前苏联国家境内，一种名为“克洛克代尔”的自制药物被广泛使用。含可待因的镇痛药（“塞达尔金”、“喷他佐辛”等）、红磷（来自火柴盒）和其他容易获取的化学成分被用于合成这种静脉注射使用的药物。颌骨骨坏死是使用“克洛克代尔”的患者出现的一种并发症。这种疾病的主要特征是口腔内颌骨暴露。手术是治疗使用“克洛克代尔”的患者颌骨骨坏死的主要方法。对40名患有颌骨骨坏死的“克洛克代尔”药物成瘾患者进行了治疗。发现11名患者（27.5%）上颌受累，21名患者（52.5%）下颌受累，8名患者（20%）上下颌均受累。在29名下颌骨中发现35处病变，在19块上颌骨中发现21处病变。治疗成功的主要因素包括：在术前（至少1个月）和术后停用“克洛克代尔”，以及向健康组织方向至少切除超出骨坏死可见边界0.5厘米的骨坏死区域。手术未延迟至死骨形成。在下颌骨进行边缘或节段性切除（有或无颞下颌关节离断）。手术后，下颌骨有8例（23%）出现疾病复发，上颌骨未出现复发病例。根据我们在这个病例系列中的经验，手术是治疗使用“克洛克代尔”的患者颌骨骨坏死的主要方法。停用药物和颌骨切除可降低此类患者的复发率。
