My husband had ORN and had his jaw replaced two years ago.

At the time of diagnosis, he was given the same two options you have been offered: (1) schedule jaw replacement surgery in the near future, at a time that would be convenient to him or (2) wait until the bone fully broke and have surgery on an "emergency" basis. Like you, he chose the second option to wait. I think he was hoping that it would never break.

In the meantime, they put him on long term antibiotics and heavy duty painkillers. It only took another 5 months before his jaw bone broke. There was no trauma...it just deteriorated until it broke.

Although the break appeared very thin on the x-ray, it was incredibly painful. My husband had to wait for three weeks for the surgeon to be able to get to him, because he is VERY much in demand and this kind of surgery is complex and time consuming. In the meantime, the pain got worse every day until it was truly unbearable. It was a very difficult time.

He was very fortunate to have his surgery with the incredible Dr. Robert Marx in Miami. The result is excellent. My husband was 80 at the time of surgery, so they gave him a titanium jaw. I understand that they prefer a bone graft for younger patients. You cannot tell he had surgery when looking at him. He had some complications after the surgery, but Dr. Marx took care of them (more HBO and IV antibiotics).

You should take a good look at the bone deterioration on your x-ray. In my husband's case, at the time he decided to wait, the x-ray showed a spot where there was about a 50% dip in the line of his jaw bone. The extent of deterioration, if visible on the x-ray, may give you some indication of how far your ORN has progressed.

If you have pain, you should know that once my husband had the surgery (and the surgery itself healed), his pain disappeared! This is the main reason why he regretted not having the surgery earlier...he could have escaped the pain sooner. If you are not in constant pain and do not have recurrent infections, you may have time to wait.

I am not a medical person, but these were our experiences with ORN and jaw replacement. In summary, my advice would be to consider (1) the extent of bone deterioration as shown on x-ray, (2) the amount of pain and (3) the frequency of infection, when deciding what to do and when to do it. I would urge you to not postpone the solution once it becomes very clear that one is needed.

Others suggested getting a second or third opinion, and I do too. This is serious stuff, so find a skilled surgeon who has dealt with your type of situation many times. They aren't usually around the corner.

Good luck to you in making the right decisions at the right time!