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RESULTS OF RADIOLOGICAL INSPECTION OF PATIENTS WITH BISFOSFONATNYMTHE OSTEONECROSIS OF JAWS (1 AND 2 GROUPS OF PATIENTS)

To all patients radiological inspection in volume was spent: OPTG and MSKT at the primary reference, and also further in dynamics for the control of formation of sequesters.

OPTG has allowed to tap the centres of a destruction of an osteal tissue in osteonecrosis areas (50 patients, 83,3 %), presence of formed sequesters (20 patients, 33,3 %).

However, in 50,0 % of cases, by results of OPTG was not possible to identify presence of the sequester localised as in face-to-face department of a jaw (in connection with applying of a shade of the spine column complicating the analysis of the image), and in distal departments of jaws, and also in the field of the firm sky, a bottom of a nasal cavity (the Drawing 18 and,).

Carrying out MSKT has allowed to solve the given problem, providing possibility to spend an estimation of presence, degree sformirovannosti sequesters, their sizes, contours and the form, and also spatial mutual relation of the centre of an osteonecrosis with the next anatomic formations.

Fig. 18. The X-ray inspection of patient SH, 75 years.

And - OPTG. The centre of a destruction of an osteal tissue in an alveolar part of a mandible on the right in a projection of an absent teeth 4 with indistinct contours. Convincing data for presence of a sequester are not present.

- MSKT. Three-dimensional reconstruction. In the field of distal departments of a body and a mandible branch the formed sequester, by length 41,6мм on the right is distinctly defined.

At carrying out of the analysis of results of X-ray inspections of patients at the primary reference following features have been taped:

1. Presence of the diffusive and localised areas of the raised density of an osteal tissue in zones of a formed necrosis is taped in 58 cases (96,7 %), (the Drawing 19).


2. At localisation of the centre of an osteonecrosis on the top jaw at 21 patients (35,0 %) signs accompanying verhnecheljustnogo a sinusitis, in 3 cases (5,0 %) - involving in process of forward departments of the firm sky (the Drawing 20а,) are taped. Among the patients having in the anamnesis of attempt of carrying out of a sinusotomy, at 2 persons it has been taped remodelirovanie walls and lumen VCHP at the expense of a peripheric osteogenesis (the Drawing 21).

Fig. 19. MSKT. An axial plane. Diffusive rising of density of an osteal tissue in the field of an osteonecrosis on a mandible at the left.


Fig. 20. And - MSKT. MPR in slantwise-sagittalnoj plane. The expressed polypiform thickening of a mucosa left verhnecheljustnogo a sine, the generated sequester in the field of a hillock of the top jaw at the left.

- MSKT. An axial plane. A formed sequester in the field of the firm sky on the right.


Fig. 21. MSKT. MPR in sagittalnoj planes. Remodelirovanie a lumen left verhnecheljustnogo a sine at the expense of peripheric kosteoobrazovanija, sequester formation.

3. At a locating of osteonecrotic process on a mandible diffusion of process to branch area is taped in 6 cases (10,0 %), (the Drawing 22а), pathological fracture is diagnosed for 1 patient (1,7 %), (the Drawing 22б). The massive, periosteal reaction assimilated with a bone is taped in 2 cases (3,3 %), (the Drawing 23).

Involving in a zone of an osteonecrosis of walls of the channel of a mandibular nerve was present at 13 patients (21,7 %), (the Drawing 24).

Fig. 22. And - MSKT. MPR in sagittalnoj planes. The generated sequester in the field of a mandible branch at the left.

- MSKT. An axial plane. The finger specifies pathological fracture in area perednebokovogo mandible department at the left.


Fig. 23. MSKT. MPR in a face-to-face projection. The periosteal reaction assimilated with a bone in the field of an osteonecrosis in perednebokovom department of a mandible.

Fig. 24. MSKT. MPR in sagittalnoj planes. A formed sequester in the field of lateral department of a mandible at the left, including the top wall of the channel of a mandibular nerve.

Data on informativnosti control MSKT are besides, obtained at treatment of patients with bisfosfonatnym an osteonecrosis of jaws. Efficiency does not cause it doubts in an estimation of dynamics of a current of an osteonecrosis, presence and degree sformirovannosti sequesters, definition

Expression degrees reparativnyh processes after treatment end (the Drawing 25, 26 and, 27а,).

Fig. 25. MSKT patients P, 68 years, at the reference. An axial plane. A zone of a diffusive osteosclerosis in an alveolar part of the top jaw on the right in the field of the small cavity remote 1.6 and teeth 1.

Fig. 26. And - MSKT patients P, 68 years, in 6 months of treatment with application of local ozonotherapy. An axial plane. The generated sequester in the field of existing before an osteosclerosis zone.

- MPR in sagittalnoj planes. The generated sequester in the field of existing before an osteosclerosis zone, integrity of the bottom wall of the right genyantrum is not broken.

Fig. 27. And-MSKT patients P, 68 years, in 6 months after a sequestectomy. An axial plane. Initial signs of an osteoreparation in the field of postoperative defect.

- MSKT patients P in 12 months after a sequestectomy. An axial plane. In the field of postoperative defect - a zone of practically full osteoreparation.

Thus, MSKT is an effective method of radial diagnostics both early, and late stages bisfosfonatnogo an osteonecrosis, and also informatively at stages of dynamic observation for an estimation reparativnyh processes at the cured patients.

Carrying out MSKT possesses a number of advantages, allowing to spend an estimation of the centre of an osteonecrosis in all possible planes and on volume images. To tap presence of periosteal reaction, pathological fractures of a jaw or process diffusion on a branch of a mandible and prilezhashchie soft tissues, and also to define the relation of the destructive centre to anatomic formations: verhnecheljustnomu to a sine, a nasal cavity and the channel of a mandibular nerve.


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Scientific source ZASLAVSKAYA NATALIA ALEKSANDROVNA. OPTIMIZATION of PREVENTIVE MAINTENANCE And TREATMENT BISFOSFONATNYH of OSTEONECROSES of JAWS At PATIENTS WITH MALIGNANT NEOPLASMS. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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  1. RESULTS OF RADIOLOGICAL INSPECTION OF PATIENTS WITH BISFOSFONATNYMTHE OSTEONECROSIS OF JAWS (1 AND 2 GROUPS OF PATIENTS)