NICO Follow-up Investigations
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Post-surgical loss or dramatic reduction of facial neuralgia-like pain  in patients with conservative surgical curettage of diseased jawbone marrow.

Review of NICO Follow-up Studies

Several follow-up studies are published (Table 1) relative to patients who have had surgical curettage of bone marrow damaged by ischemia, infarction or low-grade inflammation.  These were almost all informal surveys with the surgeon asking the patients how they were doing.  The investigations by Roberts et al. were conducted by mailed survey, a step in the right direction.  The 1995 study by Bouquot & Christian (Table 2) was the only one to not use the patients' surgeons to ask the questions, it was a mailed survey which was returned to a researcher who was unknown to them.  It was further unique in that it guaranteed anonymity, used a standard pain assessment instrument (the McGill Pain Survey), incorporated multiple questions designed to identify patients providing inconsistent data, and had follow-up as long as 18 years.

Comparison of NICO follow-up studies with those for trigeminal neuralgia

The "gold standard" for facial pain follow-up studies, excluding those relating to the temporomandibular joint disorders, is the collective body of clinical studies of patients with trigeminal neuralgia, a pain disorder which is more precisely defined than most others and one which has been studied much longer and more extensively than others.  This gold standard is considerably flawed.  Of the 85+ trigeminal neuralgia studies published up to 1998, many had such brief sections on methods & materials that it is now impossible to say how the study was performed...some had no methods section at all. Almost all studies were simple searches of the medical records of affected patients, a technique with obvious biases relative to the patient telling the doctor what the doctor wants to hear, the doctor hearing only what he or she wants to hear, etc. These are all honest mistakes but undoubtedly give a more positive outcome that anonymous surveys which guarantee anonymity.   In fact, only two studies used mailed surveys and only one used an established pain questionnaire/instrument.  The best studies were those which compared two different treatment modalities, but these are different types of studies and excluded from the present discussion.   References will eventually be posted here.

Table 1: Listing of all published follow-up studies of NICO patients.  References can be found at end of this page.

    * overlapping patient pools, i.e. some patients probably reported in multiple papers.

Table 2: Results of surgical curettage of jawbone NICO (Neuralgia-Induced Cavitational Osteonecrosis) lesions, an average of 4.5 years after last surgery, in 103 patients with "idiopathic" chronic facial pain for an average of 6 years (range: 2-18 years) prior to NICO surgery. 

Reference: Bouquot JE, Christian J. Long-term effects of jawbone curettage on the pain of facial neuralgia. J Oral Maxillofac Surg 1995; 53:387-397.

References

Ratner EJ, Person P, Kleinman DJ: Oral pathology and trigeminal neuralgia. I. Clinical experiences. J Dent Res 1976; 55:299 (abst).

Ratner EJ, Person P, Kleinman DJ, et al: Jawbone cavities and trigeminal and atypical facial neuralgias. Oral Surg 19794; 48:3-20.

Roberts AM, Person P: Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias. Oral Surg 1979; 48:298-308.

Shaber EP, Krol AJ: Trigeminal neuralgia -- a new treatment concept. Oral Surg 1980; 49:286-293.

Mathis BJ, Oatis GW, Grisius RJ: Jaw bone cavities associated with facial pain syndromes: case reports. Milit Med 1981; 146:719-723.

Wang M, Xiwei J, Qingrong I, Sanyou Z: [A study of the relation between the various trigger zones of idiopathic trigeminal neuralgia and jaw bone cavities]. Acta Acad Med Sichuan 1982; 13:233-238.

Demerath RR, Sist T: Treatment of osteocavitation lesions in facial pain patients: preliminary results. J Dent Res1982; 61:218.

Grecko VE, Puzin MN: [Odontogenic trigeminal neuralgia] Zh Nevropathol Psikhiatr 1984; 84(11):1655-1658.

Roberts AM, Person P, Chandran NB, Hori JM: Further observations on dental parameters of trigeminal and atypical facial neuralgias. Oral Surg 1984; 58: 121-129.

Ratner EJ, Langer B, Evins ML: Alveolar cavitational osteopathosis -- manifestations of an infectious process and its implication in the causation of chronic pain. J Periodontol 1986; 57:593-603.

McMahon RE, Griep J, Marfurt C: Local anesthetic effects in the presence of chronic osteomyelitis (necrosis) of the mandible: implications for localizing the etiologic site(s) of referred trigeminal pain. Anesth Prog1991; 38:189.

Bouquot JE, Christian J. Long-term effects of jawbone curettage on the pain of facial neuralgia. J Oral Maxillofac Surg 1995; 53:387-397.