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Radiographic
Features of Maxillofacial Osteonecrosis
(NICO)
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ŠThe Maxillofacial Center
for Diagnostics & Research
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Arrows point to vertical remnants of old extraction sockets still present
decades after the teeth were extracted. This "laminar rain" (lamina
dura) is not diagnostic for osteonecrosis but does show that something prevented
proper remodeling of the bone after extraction. The "X" overlies an
area of mushy, dark, oily area of "moist rot" of the mandible, i.e.
ischemic osteonecrosis.
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The Maxillofacial Center, 165 Scott Avenue, Suite 100,
Morgantown, WV 26508 USA
Phone: 304-292-4429 Fax: 304-291-5149 Email:
MFC@aol.com
Dental X-rays
When
visible on radiographs, maxillofacial osteonecrosis usually presents as a
poorly-demarcated, non-expansile radiolucency, often with irregular vertical
remnants of lamina dura (laminar rain, laminar lightning)
associated with old extraction sites. Many cases will show a faint, diffuse,
background haze, called ghost marrow, superimposed on the osteoporotic
radiolucency. This presumably results from the combination of residual calcific
necrotic debris and marrow fibrosis. In long bones, many cases show an irregular,
globular radiopacity (smoke in the chimney), but this is seldom
seen in the jaws except in cases of florid cemento-osseous dysplasia. When
it does occur in the jaws, the lesions may resemble target or bulls-eye lesions,
with a central opacity surrounded by a thick radiolucent area, which in turn
is surrounded by an thin, irregular radiopague line.
It is important to know that the disease is characterized by radiographic
variety. All of the following radiographic appearances listed below have,
for example, been demonstrated in osteonecrosis lesions, either as single
features or in combination. They are listed in order of frequency, and examples
can be viewed by clicking on the picture to the left of each descriptive term.