Neuralgia-inducing cavitational osteonecrosis - Fact or myth, the debate persists

Area of Science:

• Oral and Maxillofacial Surgery
• Neurology
• Radiology

Background:

• Neuralgia-inducing cavitational osteonecrosis (NICO) presents as cavitary lesions in the jaw, frequently causing trigeminal nerve pain.
• This condition is often misdiagnosed as atypical facial pain due to low awareness among healthcare professionals.

Observation:

• NICO lesions are often subtle and missed on standard dental radiographs.
• Bone scintigraphy is considered the gold standard for diagnosing NICO.
• The condition disproportionately affects females and can stem from trauma or chronic infection.

Findings:

• Current research suggests NICO results from ischemic alveolar bone marrow coagulation disorders, potentially involving thrombosis and hypofibrinolysis, impairing blood flow.
• Genetic mutations predisposing to thrombophilia and hypofibrinolysis are increasingly implicated in NICO development.
• Decreased bone marrow blood flow leading to bone cavities is a key pathological finding.

Implications:

• Improved diagnostic imaging and genetic analysis are vital for accurate NICO detection.
• Understanding the pathophysiology is essential for developing targeted treatment strategies.
• Further research is needed to address the lack of awareness and improve patient outcomes for NICO.