Cavitation Surgery

Jawbone cavitations, also described in the literature as fatty-degenerative osteonecrosis of the jaw (FDOJ) or bone-marrow defects (BMDJ), are abnormal areas within the jawbone in which normal bone and marrow remodeling may be altered. They may remain clinically “silent,” with little or no swelling, pus, fever, or obvious dental pain, despite pathological changes occurring within the bone. Histological investigations have reported fatty-degenerative marrow, marrow fibrosis, chronic inflammatory changes, and areas of poorly remodeled or necrotic bone.

Pioneering work by oral pathologist Dr. Jerry E. Bouquot examined 224 jawbone specimens from patients with neuralgic pain and documented chronic inflammatory changes and marrow fibrosis, describing these lesions as neuralgia-inducing cavitational osteonecrosis (NICO). Building on this work, Dr. Johann Lechner and colleagues have investigated FDOJ/BMDJ tissue and repeatedly reported markedly increased expression of the chemokine RANTES/CCL5, an important immune-signaling molecule. Their research has proposed that excessive RANTES/CCL5 activity within cavitational tissue may represent a potential pathway linking local jawbone pathology with broader immune signaling. Studies from this research group have investigated associations with conditions including multiple sclerosis, rheumatoid disease, and breast cancer. These findings are biologically significant, but current evidence does not yet establish that jawbone cavitations cause these systemic diseases. A cavitation, therefore, should not be dismissed simply because the gum looks healthy: the suspected pathology lies within the bone and requires appropriate clinical, radiological, and, when indicated, surgical/histological evaluation.