Neuralgia-inducing cavitational osteonecrosis

Neuralgia-inducing cavitational osteonecrosis (NICO) is a controversial diagnosis for cavitations (air filled spaces) in bones of the mandible (jaw or alveolar bone) and the skull claimed to manifest as trigeminal neuralgia or atypical neuralgic facial pain.cite journal |author=Bouquot JE, Roberts AM, Person P, Christian J |title=Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia |journal=Oral Surg. Oral Med. Oral Pathol. |volume=73 |issue=3 |pages=307–19; discussion 319–20 |year=1992 |month=March |pmid=1545963 |doi= |url=]

The concept has been rejected as quackery by the American College of Dentists and many dentists and maxillofacial surgeons.cite journal |author=Follmar KE |title=Taking a stand against fraud and quackery in dentistry |journal=J Am Coll Dent |volume=70 |issue=3 |pages=4–5 |year=2003 |pmid=14977370 |doi= |url=] cite journal |author=Bouquot JE, McMahon RE |title=Charlatans in dentistry: ethics of the NICO wars |journal=J Am Coll Dent |volume=70 |issue=3 |pages=38–41 |year=2003 |pmid=14977380 |doi= |url=] The concept can currently not be accepted as a medical entity because precise diagnostic criteria are lacking and there is no supporting scientific evidence (including for treatment) that does not suffer from methodological flaws.cite journal |author=Zuniga JR |title=Challenging the neuralgia-inducing cavitational osteonecrosis concept |journal=J. Oral Maxillofac. Surg. |volume=58 |issue=9 |pages=1021–8 |year=2000 |month=September |pmid=10981982 |doi=10.1053/joms.2000.8745 |url=http://linkinghub.elsevier.com/retrieve/pii/S0278-2391(00)36564-8]

The cause of NICO is allegedly avascular osteonecrosis (AO) (also known as ischemic osteonecrosis) due to chronic low-grade infection,cite journal |author=Bouquot JE, Roberts AM, Person P, Christian J |title=Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia |journal=Oral Surg. Oral Med. Oral Pathol. |volume=73 |issue=3 |pages=307–19; discussion 319–20 |year=1992 |month=March |pmid=1545963 |doi= |url=] or, in more modern versions of the theory, susceptibility to thrombosis.cite journal |author=Gruppo R, Glueck CJ, McMahon RE, "et al" |title=The pathophysiology of alveolar osteonecrosis of the jaw: anticardiolipin antibodies, thrombophilia, and hypofibrinolysis |journal=J. Lab. Clin. Med. |volume=127 |issue=5 |pages=481–8 |year=1996 |month=May |pmid=8621985 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-2143(96)90065-7] cite journal |author=Glueck CJ, McMahon RE, Bouquot JE, Triplett D, Gruppo R, Wang P |title=Heterozygosity for the Leiden mutation of the factor V gene, a common pathoetiology for osteonecrosis of the jaw, with thrombophilia augmented by exogenous estrogens |journal=J. Lab. Clin. Med. |volume=130 |issue=5 |pages=540–3 |year=1997 |month=November |pmid=9390643 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-2143(97)90132-3]

The suggested treatment for NICO involves oral surgery consisting of decortication and debridement of bone via curettage to excise dead bone from the cavitation.cite journal |author=Bouquot JE, Christian J |title=Long-term effects of jawbone curettage on the pain of facial neuralgia |journal=J. Oral Maxillofac. Surg. |volume=53 |issue=4 |pages=387–97; discussion 397–9 |year=1995 |month=April |pmid=7699492 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0278-2391(95)90708-4]

The NICO concept was first proposed in the 1970s.cite journal |author=Ratner EJ, Person P, Kleinman DJ, Shklar G, Socransky SS |title=Jawbone cavities and trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=1 |pages=3–20 |year=1979 |month=July |pmid=287984 |doi= |url=] cite journal |author=Roberts AM, Person P |title=Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias |journal=Oral Surg. Oral Med. Oral Pathol. |volume=48 |issue=4 |pages=298–308 |year=1979 |month=October |pmid=291856 |doi= |url=]

See also

* Trigeminal neuralgia
* Atypical trigeminal neuralgia
* Osteonecrosis of the jaw

Footnotes

External links

* [http://www.quackwatch.org/01QuackeryRelatedTopics/cavitation.html Cavitational Osteopathosis, NICO, and Biological Dentistry] - from Quackwatch