Radiographic Changes in Maxillofacial Osteonecrosis

Regional Osteoporosis

Sometimes the area of radiolucent, damaged marrow can be localized more specifically by the use of an occlusal radiograph.  Here an oval lesion of 1.7 cm. in greatest diameter is seen to be located toward the facial aspect of the alveolus of the left mandible.  This lesion was completely invisible on panographic radiographs but was an area of great tenderness and acted as a trigger point for the patient's lancinating (to left ear) trigeminal neuralgia pain.  

Patient with trigeminal neuralgia, CN V2.

Subpontic (Regional) Osteoporosis

One of the classic presentations of NICO is the development of facial pain after the preparation of a bridge or fixed prosthesis.   In the case to the right the patient's dentist resumed, logically, that one of the adjacent abutment teeth must have died from the crown preparation.  Endodontic therapy, however, failed to resolve the pain and resulted in radiolucencies around each of the molar apices.  Careful review of the radiograph offers an alternative explanation, namely, the scalloped radiolucency immediately beneath the cortex under the pontic was an area of tenderness.

Patient with intense local pain.