The use of denosumab in the treatment of primary chronic osteomyelitis of the mandible in children. (A review of the literature and three clinical cases)

Introduction. Primary chronic osteomyelitis is a rare disease, and all clinical cases described in the available literature are based on small numbers of samples of patients to whom different treatment methods were applied, not always with stable results. Treatment usually involves relieving symptoms with Nonsteroidal Anti-inflammatory Drugs (NSAIDs). The development of modern technologies has made it possible to obtain a new drug that can prevent pathological inflammatory bone resorption, which includes antiresorptive drugs, primarily the group of bisphosphonates and monochannel antibodies to RANKL, which have shown promising results. Material and methods. In the Department of Maxillofacial Surgery of the Russian Children’s Clinical Hospital — a branch of the Federal State Autonomous Educational Institution of Higher Education Russian National Research Medical University named after. N.I. Pirogov of the Ministry of Health of the Russian Federation of Moscow from 2015 to 2023, 45 children underwent inpatient treatment for primary chronic osteomyelitis (PCO). Of these, 17 children received combination therapy, which included decortication with removal of all granulomatous tissue and administration of the drug denosumab after negative culture results. From this number, 3 girls (5, 10, and 11 years old) with different anthropometric indicators and a persistently relapsing course were selected for this article. Results. Using this approach made it possible to lengthen the period between relapses and increase the density of the affected area in all children. However, in the case of preservation of small cystic components, we observed a relapse, which required repeated surgical treatment with sanitation of residual cystic components and the introduction of denosumab in the postoperative period, which made it possible to achieve stable remission of the disease. Conclusion. The combined approach showed good results in the form of a long relapse-free period, and the absence of severe complications of antiresorptive therapy in the form of the development of osteonecrosis of the mandible. However, it is necessary to determine the appropriate dose for use, or at least determine the duration of therapy and the frequency of administration of these drugs, since at the moment it has not yet been determined.