3-Dimensional, Thin-Sliced CT Scans of Maxillofacial Osteonecrosis

Moth-Eaten Floor of Maxillary Sinus

This 3-dimensional reconstruction of a spiral, thin-sliced CT scan of a patient with bilateral osteonecrosis of the maxilla shows numerous irregular areas of cortical destruction of the floor of the sinus on the patient's right (left in the photo).   This "moth-eaten" appearance was invisible with all other forms of imaging, but almost the entire marrow of her right zygoma (cheek bone) was destroyed by ischemic disease.  The patient has suffered from chronic allergic sinusitis.

Patient with atypical facial neuralgia.

Moth-Eaten Cortex

This patient experienced bilateral fracture of his midface as a young man.  At the age of 39 he developed trigeminal neuralgia of the second branch of the nerve on his left (right in the photo).  Notice that there has been little healing of the malar/zygomatic (cheek) bone on his left, and there remains a smaller cortical defect on his right.  His entire posterior left alveolar bone was diseased and multiple curettages of damaged marrow has not relieved his pain.  He had no trigger point for his pain.

Patient with  trigeminal neuralgia of left midface.