Princess B. Maristela | Candice Que Ansorge
Discipline: medicine (non-specific)
Background: Osteonecrosis is a condition wherein a part of the bone becomes necrotic due to ischemia. There are many etiologic factors identified but the most common is trauma. However, osteonecrosis of the maxilla is rare. During the COVID-19 pandemic, several case reports of infected patients manifested with various maxillary symptoms such as pain, swelling or exposed necrotic bone were diagnosed and were managed as osteonecrosis. These manifestations mostly happened after their recovery from COVID-19, hence, the condition was regarded as a post-COVID-19 complication. This warrants an urgent attention to study its underlying causes, and its possible relation to the COVID-19 disease process. Methods: A systematic narrative review was conducted by searching through electronic databases (PubMed, Google Scholar) without language and geographic restrictions, with inclusion publications that fits eligibility criteria set by authors, which include (1) publications between December 2019 and 2022, and (2) case of osteonecrosis of the maxilla related to COVID-19 infection. Screening and selection of studies was based on PRISMA guidelines. Descriptive statistics was used to summarize the demographic and clinical characteristics of the patients. Results: Six case reports, with a total of 21 patients, were included in the review. 66.67% of the patient population were males, and the average age of the patients were approximately 53 years. 80.95% of the patients received corticosteroid therapy. Prevalent signs and symptoms included maxillary dentoalveolar mobility, exposed necrotic bone, and alveolar crest pus oozing fistula. All patients were given antibiotic therapy, while other common treatment modalities included surgical or non-surgical debridement and curettage. Only 2 out of the 21 patients did not have a good treatment outcome due to them being immunocompromised. Conclusion: Post-COVID-19 related osteonecrosis of the jaw is a post-COVID-19 complication which is becoming increasingly reported in recent medical literature. Besides an immunocompromised status and being prescribed corticosteroid therapy, this review points out the possibility of male sex and older age to be independent risk factors of this complication. Wider study into this complication is warranted to determine the underlying pathophysiologic mechanisms to derive evidence-based recommendations for its effective treatment and management.
ISSN 0031-7799 (Print)
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