Ho Chi Minh CityHo Chi Minh City Central Hospital of Odonto-Stomatology received 16 patients, Ear Nose Throat Hospital treated 5 people with jaw bone necrosis, since the beginning of the year until now.
On July 13, Doctor Nguyen Van Tuan, Head of the Department of Maxillofacial Surgery, Ho Chi Minh City Central Hospital of Odonto-Stomatology, said that in 16 patients with maxillary bone necrosis, there were three cases of necrosis spreading to the floor. skull, involved many specialties, so this place was transferred to Cho Ray Hospital for surgery.
The remaining 13 cases were surgically removed from the necrotic upper jaw, followed by antibiotics for at least three weeks. It is expected that after 6 months of follow-up, if the condition is stable and there is no recurrence, the patient will be reconstructed and restored the upper jaw bone. “Currently, the patients are fine, there are no signs of recurrence,” said Dr. Tuan.
According to Dr. Tuan, osteonecrosis of the jaw usually occurs in the lower jaw because there are fewer blood vessels to nourish than the upper jaw bone. Previously, every few months, the hospital received a new case of mandibular necrosis, usually caused by radiation therapy for head and neck cancer or by taking anti-osteoporotic drugs. A few cases of osteonecrosis of the upper jaw admitted to the hospital are usually related to patients with diabetes, because this disease affects the blood vessels that nourish the bones, or reduces the resistance, and is susceptible to bacterial and fungal attacks. bone death.
“After the outbreak of Covid, from about February to now, the number of patients examining the maxillary bone necrosis has increased dramatically, but the cause is unknown, different from before, it was mainly patients who examined the lower jaw and the cause was clear.” , the doctor said and said that the disease is now more serious than before, the necrotic area is more widespread. The patients all had Covid and were admitted to the hospital with symptoms such as loose teeth and jawbone, pus discharge, painful swelling of the roof of the mouth, sores and exposed upper jaw bone.
Dr. Le Tran Quang Minh, Director of the Ho Chi Minh City Ear, Nose and Throat Hospital, said that this place has recorded 5 cases of maxillary sinusitis since the beginning of the year. In which, three cases occurred in diabetic patients, two cases of invasive fungus causing osteomyelitis of the maxilla. The patients underwent surgery to remove the infection, remove the necrotic inflammatory tissue, and take antibiotics. After the treatment was stable, all patients were discharged from the hospital. The hospital did not record whether the patient had previously had Covid-19 or not.
In the past two months, Cho Ray Hospital has received 11 patients with symptoms of headache, nasal congestion, swelling of the face and eyes, progressing gradually, but treatment, including surgery, still failed. Two people died after that, 6 people asked to go home, 3 people were successfully treated by surgery. The doctor noted that the patients had osteomyelitis of the maxilla, osteomyelitis of the skull base. The hospital has not determined the cause of bone necrosis in these patients, but the common point is that they have been infected with Covid-19 and have no history of ENT disease or maxillofacial disease.
Director of Ho Chi Minh City Department of Health Tang Chi Thuong said that this is a “new problem”, asking hospitals to survey and synthesize cases. The city will meet with experts to accurately assess the situation, clarify the cause of the disease, and access data from around the world and take the next course of action.
Doctors said that so far it has not been possible to confirm whether the recent increase in osteonecrosis is related to Covid-19. From May 2021 to May this year, the world literature recorded about 80 reports of patients with osteonecrosis of the skull and maxillofacial bone, mainly in India, China, many Asian countries and some countries. Europe, America. Most patients from countries with underlying diseases, diabetes, had Covid-19 when the Delta mutation broke out.
According to Dr. Tuan, the literature offers 4 risk factors for maxillary osteonecrosis. Firstly, nCoV attaches to the ACE2 receptor (which is abundant in the lining of the nose and mouth), causing vascular complications, capable of blocking blood vessels supplying bones, and having Covid-19 also causes increased blood clotting, decreased blood supply. bone leading to necrosis. In addition, the use of corticosteroids (anti-inflammatory) in the treatment regimen for Covid-19 can also make bone nourishment worse. Another risk factor is that the patient has an opportunistic bacterial or fungal infection. Finally, patients with underlying diseases, especially diabetes, will be prone to bone necrosis because the disease reduces blood vessel nutrition, reduces resistance, affects white blood cell function, so it is easy to superinfect…
Dr. Le Quoc Hung, Head of the Department of Tropical Diseases, Cho Ray Hospital, said that in the past it was very rare for people with diabetes to have osteomyelitis, but after Covid-19 appeared, the world recorded many cases. Normally, the surrounding environment has many types of microorganisms, when the body is immunocompromised, such as diabetes, it will be easily attacked. “The body of a person with Covid has a long-term immune disorder, plus that underlying disease, which can lead to the fungus growing more in the body, causing inflammation,” Dr. Hung analyzed. In 11 cases at Cho Ray Hospital, there are 5 patients with diabetes.
Doctors believe that early detection and timely treatment can prevent the progression of bone necrosis. If the necrosis spreads to the skull floor, the level of danger increases, easily leading to death. If a patient has symptoms such as headache, pain in the molars, swelling in the face, after contracting Covid, they need to see a doctor.