Autopsy Case of Ischemic Osteonecrosis

The first autopsy example of NICO was published in the Journal of Oral Pathology & Medicine in 1999. This photo, from that case, illustrates a subcortical region of mushy brown marrow with microcavitations (arrows), located in the mandibular second and third molar region. This was barely visible on radiographs and the patient had been previously treated, unsuccessfully (prior to NICO therapy),  for atypical facial neuralgia/pain of this nerve branch and trigeminal neuralgia of the second trigeminal nerve branch. Notice the glistening brown/gray semitranslucent material around the inferior alveolar nerve. The nerve canal is mostly destroyed by the disease, leaving this "gelatinous marrow," a sign of ischemic damage.