A сomplication of COVID-19 in the maxillofacial region. Сlinical cases

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Abstract

This study focuses on the clinical symptoms of inflammatory and destructive lesions of the facial skeletal bones as a long-term complication of coronavirus disease-2019 (COVID-19). The most common symptom of COVID-19 is thrombosis. Many scientists have noted that the main target of COVID-19 is the lungs with varying damage severity in the form of pneumonia. Acute cerebrovascular accidents and coronary pathology have become the most common causes of lethal outcomes in young people. Clinically, in patients with COVID-19, both obvious thrombotic complications were recorded with large thrombi detection (not only in the veins and pulmonary arteries, but also in the heart and vessels of the brain, kidneys, and liver), as well as signs of thrombosis at the microcirculatory level, which is quite difficult to establish in vivo. The diagnostics, treatment, and follow-up of a patient with COVID-19 history and complications that arose in the maxillofacial region were conducted in the Department of Maxillofacial Surgery of Clinical Hospital. Upon admission, the patient was diagnosed with chronic osteomyelitis of the upper jaw on the right, chronic right-sided maxilloethmoidal sinusitis, mucous membrane defect on the right hard palate, oroantral fistula on the right, and keratitis of the right eye. During the inpatient treatment, multicomponent therapy was performed. During the therapy, a general condition and local status improvement of the patient was noted.

CONCLUSIONS: The clinical cases indicate that the course of COVID-19 is characterized by late complications in the maxillofacial region in the form of damaged vessels that extend from the а. maxillaris trunk in the pterygopalatine fossa region.

The trophic disorder was slowly progressive and irreversible. The clinical and radiological presentation showed no clearly defined boundaries of bone necrosis of the facial middle zone. Low tissue regeneration was noteworthy.

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About the authors

Natalya M. Khelminskaya

N.I. Pirogov Russian National Research Medical University

Author for correspondence.
Email: khelminskaya@mail.ru
ORCID iD: 0000-0002-3627-9109

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Aleksandra V. Posadskaya

N.I. Pirogov Russian National Research Medical University

Email: shush79@mail.ru
ORCID iD: 0000-0002-5926-8541

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, Moscow

Viktor I. Kravets

N.I. Pirogov Russian National Research Medical University

Email: vi_kravets@mail.ru
ORCID iD: 0000-0002-6345-3993

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, Moscow

Irina A. Pavlova

City Сlinical Hospital No 1

Email: personal2032@mail.ru
ORCID iD: 0000-0002-6564-2595
Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Oedema of soft tissues and fistula in the area of the jaw osteonecrosis.

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2. Fig. 2. Osteonecrosis of the hard palate. View of the hard palate of a patient with maxillary osteonecrosis.

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3. Fig. 3. View of the oral cavity vestibule of a patient with osteonecrosis.

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4. Fig. 4. Rhinosinusoscopy. View of the maxillary sinus of a patient with osteonecrosis.

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5. Fig. 5. CT in the frontal plane: destruction of the maxillary bone, the body of the zygomatic bone, pathological contents of the maxillary sinus, defect in the bone of the alveolar edge of the upper jaw.

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6. Рис. 6. Компьютерная томограмма в саггитальной проекции: деструкция кости верхней челюсти, тела скуловой кости, патологическое содержимое верхнечелюстной пазухи.

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7. Fig. 7. Computed 3D tomography scan: destruction of the bone of the anterior wall of the maxillary sinus, the body of the zygomatic bone, and the alveolar ridge of the upper jaw.

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