More recently, Kagan and Schwartz described a three stage clinical
staging system.23 This staging system differs significantly from
the system created by Marx because the disease is classified based
on clinical and radiologic findings and treatment is determined
based on the stage, similar to the approach for malignancies of
the head and neck. Stage I is defined as minimal soft tissue ulceration
and limited exposed cortical bone. These patients are treated
with conservative management. A small number of patients progress
to Stage II. Stage II is defined as localized involvement of
the mandibular cortex and underlying medullary bone. Stage II is
divided into groups a and b. Stage IIa has minimal soft tissue ulceration.
Stage IIb is defined based on the presence of an oro-cutaneous
fistula and mild soft tissue necrosis. Again, the majority resolve
with conservative management or minor surgical procedures.
Stage III is classified based on full thickness involvement of the
bone, including the inferior border. Pathological fracture may also be present. All require surgical intervention, including bone and/or
soft-tissue replacement.