LOCAL-ANESTHETIC EFFECTS IN THE PRESENCE OF CHRONIC OSTEOMYELITIS (NECROSIS) OF THE MANDIBLE - IMPLICATIONS FOR LOCALIZING THE ETIOLOGIC SITES OF REFERRED TRIGEMINAL PAIN

The aims of this study were: (1) to demonstrate how reproducible varia tions in incomplete anesthesia of the inferior alveolar nerve can be s ued an a guide to locate the etiologic sites of referred trigeminal pa in emanating from the mandible; (2) to describe the salient histopatho logic features of a low-grade, nonsuppurative osteomyelitis seen in th is patient population. Forty-six patients with idiopathic facial pain were subjected to a specific protocol of local anesthetic injections t o sequentially block branches of the mandibular nerve to determine the effects on his/her pain. If this significantly reduced or altered the pain on three separate appointments, then exploratory surgery was con ducted near identified zones of unanesthetized gingiva. Blocking (92%) , bridging (4%), and divergence (4%) were observed patterns of anesthe tic resistance of the mucogingival tissues used to categorize the inco mplete anesthesia. A 100% correlation was found between the identified zones of unanesthetized gingiva and the discovery of intramedullary p athology. Medullary fibrosis with ischemic and degenerative changes in the cancellous bone were common findings, along with chronic inflamma tory cell infiltrates and clusters of lymphocytes. It is concluded tha t Ratner's method of diagnostic anesthesia be implemented when searchi ng for occult pain producing pathology of the jaws.