title: Osteonecrosis of the maxilla related to long-standing methamphetamine abuse: a possible new aspect in the etiology of osteonecrosis of the jaw.
abstract: BACKGROUND
  Osteonecrosis of the jaw (ONJ) related to toxic effects of illicit drugs such as cocaine is not very common and might be overshadowed today by the incidence of bisphosphonate-related osteonecrosis of the jaw. However, we present a case which suggests a close relationship between abuse of the illicit drug methamphetamine (MA) and ONJ.
  
  
  METHODS
  A 44-year-old male with extended osteonecrosis of the maxilla admitted chronic abuse and synthesis of MA for at least the previous two decades. Furthermore, he confessed self-extracting teeth since he became addicted to MA. However at presentation, he had been successfully cured of his addiction to MA. A step-by-step surgical treatment was planned using computer-aided design/computer-aided manufacturing techniques. After resection of necrotic bone, a vascularized osteomyocutaneous fibular flap was applied secondarily.
  
  
  CONCLUSIONS
  Two possible mechanisms, alone or in combination, could possibly lead to MA-related ONJ. Self-extraction of teeth as a psychopathologic behavior of self-destruction among MA abusers results in wounds that allow unhindered invasion of microorganisms causing osteomyelitis and ONJ, while on the other hand, the heating of white phosphor releases toxic phosphorous vapor, which could be inhaled and consequently cause ONJ of the maxilla. However, since the worldwide prevalence of MA abuse is remarkably high, a relationship between MA abuse and ONJ will offer a new aspect in the etiology of ONJ and might present a further therapeutic challenge.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Klinikum Bremen-Mitte, School of Medicine, University of Göttingen, Bremen, Germany, janrustem@gmx.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Rustemeyer
authors.forename: Alex
authors.initials: A
authors.lastname: Melenberg
authors.forename: Klaus
authors.initials: K
authors.lastname: Junker
authors.forename: Aynur
authors.initials: A
authors.lastname: Sari-Rieger
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications*; D016025:Bone Transplantation; D017076:Computer-Aided Design; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008439:Maxillary Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D008694:Methamphetamine / Q000633:toxicity*; D008866:Microsurgery; D064847:Multimodal Imaging; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D008694:Methamphetamine
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