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Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial pains

Identifieur interne : 002E84 ( Istex/Curation ); précédent : 002E83; suivant : 002E85

Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial pains

Auteurs : William R. Adams [États-Unis] ; Kenneth J. Spolnik [États-Unis] ; Jerry E. Bouquot [États-Unis]

Source :

RBID : ISTEX:5F7E7EDC00D6C5AF44BBE1C75BC2F956B060C241

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Abstract

Adams WR, Spolnik KJ, Bouquot JE: Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial pains. J Oral Pathol Med 1999; 28: 423–32. © Munksgaard, 1999. Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53‐year‐old man with multiple debilitating, “idiopathic” chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia‐inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.

Url:
DOI: 10.1111/j.1600-0714.1999.tb02101.x

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ISTEX:5F7E7EDC00D6C5AF44BBE1C75BC2F956B060C241

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<name sortKey="Adams, William R" sort="Adams, William R" uniqKey="Adams W" first="William R." last="Adams">William R. Adams</name>
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<mods:affiliation>Indiana University School of Dentistry, Indianapolis, Indiana</mods:affiliation>
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<mods:affiliation>The Maxillofacial Center, Morgantown, West Virginia, USA</mods:affiliation>
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<keywords scheme="KwdEn" xml:lang="en">
<term>Abnormal marrow</term>
<term>Aggregated fibrin</term>
<term>Alveolar bone</term>
<term>Alveolar nerve</term>
<term>American academy</term>
<term>Anterior maxillary</term>
<term>Arlet mazieres</term>
<term>Avascular necrosis</term>
<term>Blood flow</term>
<term>Bone circulation</term>
<term>Bone healing</term>
<term>Bone marrow</term>
<term>Bone marrow edema syndrome</term>
<term>Bone necrosis</term>
<term>Bone pain</term>
<term>Bouquot</term>
<term>Cancellous bone</term>
<term>Cavitation</term>
<term>Cavitations</term>
<term>Chronic idiopathic</term>
<term>Chronic pain</term>
<term>Clin orthop</term>
<term>Consecutive weeks</term>
<term>Constant pain</term>
<term>Craniomand pract</term>
<term>Curettage</term>
<term>Current concepts</term>
<term>Cuspid</term>
<term>Cuspid region</term>
<term>Dead adipocytes</term>
<term>Dense fibrosis</term>
<term>Dent</term>
<term>Dental pain</term>
<term>Edema</term>
<term>Estrogen therapy</term>
<term>Etiology</term>
<term>Facial</term>
<term>Facial neuralgia</term>
<term>Facial neuralgias</term>
<term>Facial pain</term>
<term>Facial pains</term>
<term>Fatty marrow</term>
<term>First molar region</term>
<term>Focal area</term>
<term>Gelatinous marrow</term>
<term>Glueck</term>
<term>Glueck freiberc glueck</term>
<term>Glueck mcmahon</term>
<term>Hypofibrinolysis</term>
<term>Idiopathic</term>
<term>Inferior alveolar</term>
<term>Inferior alveolar canal</term>
<term>Inflammatory cells</term>
<term>Inflammatory changes</term>
<term>Intramedullary</term>
<term>Intramedullary hypertension</term>
<term>Intramedullary ischemia</term>
<term>Intramedullary pressures</term>
<term>Intraosseous</term>
<term>Intravascular coagulation</term>
<term>Ischemia</term>
<term>Ischemic</term>
<term>Ischemic osteonecrosis</term>
<term>Isotope uptake</term>
<term>Lancinating</term>
<term>Lancinating pain</term>
<term>Lingual half</term>
<term>Mandible</term>
<term>Mandibular</term>
<term>Marrow</term>
<term>Marrow veins</term>
<term>Maxillary</term>
<term>Maxillofacial</term>
<term>Maxillofacial bones</term>
<term>Maxillofacial center</term>
<term>Maxillofacial region</term>
<term>Mcmahon</term>
<term>Microscopic features</term>
<term>Minimal fibrosis</term>
<term>Molar</term>
<term>Mucosal temperature</term>
<term>Multiple areas</term>
<term>Necrosis</term>
<term>Nerve damage</term>
<term>Neuralgia</term>
<term>Neurovascular bundle</term>
<term>Nico</term>
<term>Nico cavitational osteonecrosis</term>
<term>Nico patients</term>
<term>Normal marrow</term>
<term>Oral pathol</term>
<term>Oral surg</term>
<term>Orthop</term>
<term>Orthopaedic surgeons</term>
<term>Osteocyte</term>
<term>Osteonecrosis</term>
<term>Other bones</term>
<term>Painful quadrant</term>
<term>Pathol</term>
<term>Poor outflow</term>
<term>Present case report</term>
<term>Previous investigations</term>
<term>Previous surgery</term>
<term>Prosthet dent</term>
<term>Quadrant</term>
<term>Radioisotope uptake</term>
<term>Several areas</term>
<term>Sharp pain</term>
<term>Sickle cell disease</term>
<term>Strong association</term>
<term>Surg</term>
<term>Surgical exploration</term>
<term>Syndrome</term>
<term>Thrombophilia</term>
<term>Tissue processing</term>
<term>Transient ischemic osteoporosis</term>
<term>Trigeminal</term>
<term>Trigeminal nerve</term>
<term>Trigeminal neuralgia</term>
<term>Trigeminal pain</term>
<term>University neurology service</term>
<term>Urbaniak jones</term>
</keywords>
<keywords scheme="Teeft" xml:lang="en">
<term>Abnormal marrow</term>
<term>Aggregated fibrin</term>
<term>Alveolar bone</term>
<term>Alveolar nerve</term>
<term>American academy</term>
<term>Anterior maxillary</term>
<term>Arlet mazieres</term>
<term>Avascular necrosis</term>
<term>Blood flow</term>
<term>Bone circulation</term>
<term>Bone healing</term>
<term>Bone marrow</term>
<term>Bone marrow edema syndrome</term>
<term>Bone necrosis</term>
<term>Bone pain</term>
<term>Bouquot</term>
<term>Cancellous bone</term>
<term>Cavitation</term>
<term>Cavitations</term>
<term>Chronic idiopathic</term>
<term>Chronic pain</term>
<term>Clin orthop</term>
<term>Consecutive weeks</term>
<term>Constant pain</term>
<term>Craniomand pract</term>
<term>Curettage</term>
<term>Current concepts</term>
<term>Cuspid</term>
<term>Cuspid region</term>
<term>Dead adipocytes</term>
<term>Dense fibrosis</term>
<term>Dent</term>
<term>Dental pain</term>
<term>Edema</term>
<term>Estrogen therapy</term>
<term>Etiology</term>
<term>Facial</term>
<term>Facial neuralgia</term>
<term>Facial neuralgias</term>
<term>Facial pain</term>
<term>Facial pains</term>
<term>Fatty marrow</term>
<term>First molar region</term>
<term>Focal area</term>
<term>Gelatinous marrow</term>
<term>Glueck</term>
<term>Glueck freiberc glueck</term>
<term>Glueck mcmahon</term>
<term>Hypofibrinolysis</term>
<term>Idiopathic</term>
<term>Inferior alveolar</term>
<term>Inferior alveolar canal</term>
<term>Inflammatory cells</term>
<term>Inflammatory changes</term>
<term>Intramedullary</term>
<term>Intramedullary hypertension</term>
<term>Intramedullary ischemia</term>
<term>Intramedullary pressures</term>
<term>Intraosseous</term>
<term>Intravascular coagulation</term>
<term>Ischemia</term>
<term>Ischemic</term>
<term>Ischemic osteonecrosis</term>
<term>Isotope uptake</term>
<term>Lancinating</term>
<term>Lancinating pain</term>
<term>Lingual half</term>
<term>Mandible</term>
<term>Mandibular</term>
<term>Marrow</term>
<term>Marrow veins</term>
<term>Maxillary</term>
<term>Maxillofacial</term>
<term>Maxillofacial bones</term>
<term>Maxillofacial center</term>
<term>Maxillofacial region</term>
<term>Mcmahon</term>
<term>Microscopic features</term>
<term>Minimal fibrosis</term>
<term>Molar</term>
<term>Mucosal temperature</term>
<term>Multiple areas</term>
<term>Necrosis</term>
<term>Nerve damage</term>
<term>Neuralgia</term>
<term>Neurovascular bundle</term>
<term>Nico</term>
<term>Nico cavitational osteonecrosis</term>
<term>Nico patients</term>
<term>Normal marrow</term>
<term>Oral pathol</term>
<term>Oral surg</term>
<term>Orthop</term>
<term>Orthopaedic surgeons</term>
<term>Osteocyte</term>
<term>Osteonecrosis</term>
<term>Other bones</term>
<term>Painful quadrant</term>
<term>Pathol</term>
<term>Poor outflow</term>
<term>Present case report</term>
<term>Previous investigations</term>
<term>Previous surgery</term>
<term>Prosthet dent</term>
<term>Quadrant</term>
<term>Radioisotope uptake</term>
<term>Several areas</term>
<term>Sharp pain</term>
<term>Sickle cell disease</term>
<term>Strong association</term>
<term>Surg</term>
<term>Surgical exploration</term>
<term>Syndrome</term>
<term>Thrombophilia</term>
<term>Tissue processing</term>
<term>Transient ischemic osteoporosis</term>
<term>Trigeminal</term>
<term>Trigeminal nerve</term>
<term>Trigeminal neuralgia</term>
<term>Trigeminal pain</term>
<term>University neurology service</term>
<term>Urbaniak jones</term>
</keywords>
</textClass>
</profileDesc>
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<front>
<div type="abstract" xml:lang="en">Adams WR, Spolnik KJ, Bouquot JE: Maxillofacial osteonecrosis in a patient with multiple “idiopathic” facial pains. J Oral Pathol Med 1999; 28: 423–32. © Munksgaard, 1999. Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53‐year‐old man with multiple debilitating, “idiopathic” chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia‐inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.</div>
</front>
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