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

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


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.

Full Text

Restricted Access

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


  1. covid19.who.int [Internet]. [cited 18 August 2021]. Available from: https://covid19.who.int/cardioweb.ru [Internet]. Narusheniya svertyvaniya krovi u patsientov s COVID-19: rekomendatsii ekspertov [cited 18 August 2021]. Available from: https://cardioweb.ru/news/item/2129-narusheniya-svertyvaniya-krovi-u-patsientov-s-covid-19-rekomendatsii-ekspertov(In Russ).
  2. Blanco-Melo D, Nilsson-Payant BE, Liu WC, et al. Imbalanced Host Response to SARS-CoV-2 Drives Development of COVID-19. Cell. 2020;181(5):1036–1045 e1039. doi: 10.1016/j.cell.2020.04.026
  3. Catanzaro M, Fagiani F, Racchi M, et al. Immune response in COVID-19: addressing a pharmacological challenge by targeting pathways triggered by SARS-CoV-2. Signal Transduct Target Ther. 2020;5(1):84. doi: 10.1038/s41392-020-0191-1
  4. Group RC, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693–704. doi: 10.1056/NEJMoa2021436
  5. Cowan LT, Lutsey PL, Pankow JS, et al. Inpatient and Outpatient Infection as a Trigger of Cardiovascular Disease: The ARIC Study. J Am Heart Assoc. 2018;7(22):e009683. doi: 10.1161/JAHA.118.009683
  6. Nagai T, Nitta K, Kanasaki M, et al. The biological significance of angiotensin-converting enzyme inhibition to combat kidney fibrosis. Clin Exp Nephrol. 2015;19(1):65–74. doi: 10.1007/s10157-014-1000-3
  7. youtube.com [Internet]. ACC/Chinese Cardiovascular Association COVID-19 Webinar 1 [cited 18 August 2021]. Available from: https://www.youtube.com/watch?v=CjEhV68GcD8
  8. Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023–1026. doi: 10.1111/jth.14810
  9. academy.isth.org [Internet]. OBE BH, Retter A, McClintock C. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19 [cited 18 August 2021]. Available from: https://academy.isth.org/isth/document_library?dc_id=9449&f=menu%3D8%2Abrowseby%3D8%2Asortby%3D2%2Alabel%3D19794
  10. Kozlov IA, Tyurin IN. Cardiovascular complications of COVID-19. Messenger of anesthesiology and resuscitation. 2020;17(4):14–22. (In Russ). doi: 10.21292/2078-5658-2020-17-4-14-22
  11. Ivanov MB, Shustov EB, Litvintsev BS, et al. Endothelial dysfunction as a link in COVID-19 pathogenesis. Medline.ru. 2020;21(71):884–903. (In Russ).
  12. Larina VN, Golovko MG, Larin VG. Possible effects of coronavurus infection (COVID-19) on the cardiovascular system. Bulletin of RGMU. 2020(2-2020). (In Russ). doi: 10.24075/vrgmu.2020.020
  13. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020;382(17):e38. doi: 10.1056/NEJMc2007575

Supplementary files

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

Download (160KB)
2. Fig. 2. Osteonecrosis of the hard palate. View of the hard palate of a patient with maxillary osteonecrosis.

Download (185KB)
3. Fig. 3. View of the oral cavity vestibule of a patient with osteonecrosis.

Download (139KB)
4. Fig. 4. Rhinosinusoscopy. View of the maxillary sinus of a patient with osteonecrosis.

Download (131KB)
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.

Download (193KB)
6. Рис. 6. Компьютерная томограмма в саггитальной проекции: деструкция кости верхней челюсти, тела скуловой кости, патологическое содержимое верхнечелюстной пазухи.

Download (201KB)
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.

Download (154KB)

Copyright (c) 2021 Eco-Vector

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: 01016 от 19.07.1995 г
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80632 от 15.03.2021 г

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies