Bouquot J E, Christian J
Maxillofacial Center for Diagnostics and Research, Morgantown, WV, USA.
J Oral Maxillofac Surg. 1995 Apr;53(4):387-97; discussion 397-9. doi: 10.1016/0278-2391(95)90708-4.
To evaluate the dimension and duration of pain reduction in patients with facial neuralgias after localization, decortication, and curettage of histologically confirmed inflammatory jawbone lesions of the newly identified form of alveolar avascular osteonecrosis called neuralgia-inducing cavitational osteonecrosis (NICO).
One hundred ninety patients who could be located retrospectively and who had histories of jawbone curettage for chronic "idiopathic" facial pain, either trigeminal neuralgia (TN) or atypical facial neuralgia/pain (AFN), were identified through surgical pathology reports from four institutions. To assess pain reduction after jawbone surgery, these patients were mailed a modified McGill Pain Survey by investigators with whom they had had no previous professional contact. Patient demographics and clinicopathologic characteristics were also reviewed through surgical pathology specimens and reports.
More than two thirds of the respondents to whom the questionnaire was mailed experienced complete or almost complete disappearance of neuralgic pain immediately or shortly after curettage of jawbone osteonecrosis (NICO), regardless of whether they had previously been diagnosed with TN or AFN. Thirty percent, however, experienced local recurrence of jaw inflammation and facial pain, and one third developed at least one and as many as 12 additional foci of histologically confirmed osteonecrosis. Despite this, however, the long-term (average, 4.6 years) abatement of neuralgic pain was total or almost total in 74% of treated patients.
Neuraglia-inducing cavitational osteonecrosis appears to be associated with at least some cases of facial neuralgia, or with a pain so similar as to be clinically indistinguishable. Decortication and curettage dramatically reduces or eliminates this intense pain in two of every three patients, although multiple surgeries may be required, and additional sites of osteonecrosis may occur. It is recommended that NICO be included in the differential diagnosis of idiopathic facial pain syndromes.
评估新发现的一种牙槽骨无血管性骨坏死（称为神经痛诱发的空洞性骨坏死，NICO）组织学确诊的炎性颌骨病变经定位、去皮质和刮除术后，面部神经痛患者疼痛减轻的程度和持续时间。
通过四家机构的手术病理报告，确定了190例可进行回顾性定位且有因慢性“特发性”面部疼痛（三叉神经痛，TN，或非典型面部神经痛/疼痛，AFN）行颌骨刮除术病史的患者。为评估颌骨手术后的疼痛减轻情况，调查人员向这些患者邮寄了一份改良的麦吉尔疼痛问卷，调查人员与患者此前无专业接触。还通过手术病理标本和报告回顾了患者的人口统计学和临床病理特征。
无论之前诊断为TN还是AFN，超过三分之二收到问卷的受访者在颌骨骨坏死（NICO）刮除术后立即或不久，神经痛性疼痛完全或几乎完全消失。然而，30%的患者颌部炎症和面部疼痛出现局部复发，三分之一的患者出现至少1个且多达12个经组织学确诊的骨坏死额外病灶。尽管如此，74%接受治疗的患者神经痛性疼痛长期（平均4.6年）完全或几乎完全缓解。
神经痛诱发的空洞性骨坏死似乎与至少部分面部神经痛病例相关，或与临床难以区分的疼痛相关。去皮质和刮除术可使三分之二的患者剧痛显著减轻或消除，尽管可能需要多次手术，且可能出现额外的骨坏死部位。建议将NICO纳入特发性面部疼痛综合征的鉴别诊断。
