Post-COVID Mandibular Necrosis Syndrome
The COVID-19 Pandemic has been a significant burden upon the population since its beginning, with the SARS-CoV-2 virus that causes Coronavirus disease estimated to have infected at least 606 million people and caused at least 6.51 million deaths worldwide, as of September 2022. Statistics such as these are critical, as they account for the most important and serious of short-term outcomes resulting from infection with SARS-CoV-2 (either recovery from infection, or death due to infection). However, for those fortunate enough to have survived the infection, these statistics do not tell the whole story behind what Coronavirus infection can lead to.
One large part of this story is “Long-COVID”, a post-infection syndrome which is fast becoming among the biggest problems facing the population in the post-vaccine period of the pandemic. Long-COVID is defined as COVID-19-associated symptoms “where symptoms of COVID-19 remain, or develop, long after the initial infection – usually after 4 weeks”. Common symptoms of this syndrome include fatigue, chest pain, memory loss, changes in the taste and smell senses, and pain in joints or muscles. However, one uncommon but emerging and extremely serious complication of Long-COVID is “Post-COVID Mandibular Necrosis Syndrome” (PCMNS), which is a sudden complication of the face and jaw that leads to the death of the bones within these zones (Al-Mahalawy et al., 2022; Fakhar et al., 2022; Mañón et al., 2022; Slavkova & Nedevska, 2022).
Evidence of how PCMNS develops is still in the very early stages of being collected, as the phenomenon has only recently been described; however, it is commonly observed in patients at a timepoint of no less than 3 weeks following what is often a severe infection with SARS-CoV-2. The syndrome presents as pain, swelling or difficulty in motion of the jaw or facial bones (Al-Mahalawy et al., 2022; Fakhar et al., 2022; Mañón et al., 2022; Slavkova & Nedevska, 2022). Upon medical examination, PCMNS is characterised by bone death in the jaw and often facial bones that features oozing, pus-filled lesions in the affected areas (Al-Mahalawy et al., 2022). While the jaw appears to be one key area affected, the cheekbones and nasal sinus zones have also been noted as being affected, with surgery commonly necessary to remove dead bone and tissue from patients (Al-Mahalawy et al., 2022; Fakhar et al., 2022; Mañón et al., 2022; Slavkova & Nedevska, 2022). Patients who have presented to doctors with PCMNS have commonly been quoted with bewildering and horrifying descriptions of their unfortunate conditions, including:
- One patient who described a sensation of “peeling” within their mouth, as well as a continually-pulsing right-side of the face (Slavkova & Nedevska, 2022);
- Another patient who visited a surgeon with an exposed upper jaw bone (Mañón et al., 2022).
- A patient with floating teeth within their mouth, along with an accompanying ulceration of the nose (Fakhar et al., 2022).
While the exact cause for the development of PCMNS is not well-understood, it is believed that a number of factors relating to the course of a COVID infection are involved. These factors include (Al-Mahalawy et al., 2022):
- Severe infection with SARS-CoV-2 that causes the body to produce an excessive immune reaction and severely damage the body, as well as inducing a heightened risk of excessive clotting within the body;
- Pre-existing diseases that amplify the effect of COVID-19 (particularly diabetes and other vascular diseases);
- Additional infections of the jaw and face area by bacteria or fungi that amplify the damage and degradation observed within the bones of PCMNS patients;
- The necessary use of specific medications (such as corticosteroids) during COVID-19 infection – it is noted that these pharmaceuticals are required to prevent the death of the patient during the severe breathing difficulty phase.
Given the above factors that appear to be common occurrences in people who present with PCMNS, it is reasonable to observe that the prevention of severe COVID-19 infection and an improvement in a person’s general health would likely decrease the risk of developing PCMNS. While the chances of preventing severe COVID-19 infection are improved dramatically, where possible, through vaccination (Feikin et al., 2022), it is also likely that maintaining a healthy lifestyle and following medical advice on how to prevent yourself from acquiring COVID-19 infection would also be of significant help in the prevention of developing PCMNS.
Al-Mahalawy H et al. Post-COVID-19 related osteonecrosis of the jaw (PC-RONJ): an alarming morbidity in COVID-19 surviving patients. BMC Infect Dis. 2022 Jun 14;22(1):544.
Fakhar M et al. Post-COVID-19 maxillary osteonecrosis and floating maxillary teeth due to mucormycosis in two uncontrolled diabetic patients. Clin Case Rep. 2022 Mar 10;10(3):e05502.
Feikin et al. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression. Lancet. 2022 Mar 5;399(10328):924-944.
Mañón VA et al. COVID-Associated Avascular Necrosis of the Maxilla-A Rare, New Side Effect of COVID-19. J Oral Maxillofac Surg. 2022 Jul;80(7):1254-1259.
Slavkova N, Nedevska M. Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment. Radiol Case Rep. 2022 Jul 2;17(9):3228-3232.