Osteoradionecrosis (ORN)

Last modified on August 1st, 2018

Osteoradionecrosis (ORN)

Osteoradionecrosis – ORN – Is a complication of radiotherapy treatment to the head and neck resulting in necrosis (or death) of the mandible (Lower jaw) usually.

It can occur in up to 10% of patients undergoing treatment.

Historically this was thought to be due to decreased blood supply and resulting decreased oxygen levels in the bone of the mandible, which led to many advocating the use of hyperbaric oxygen therapy to manage it. However, the benefit for this treatment has largely been refuted. Consequently this form of treatment is no longer offered outside of a clinical trial.

Sometimes there is a triggering event such as a dental extraction or implant surgery, which gives rise to an exposed area of jaw bone or a slow healing socket. This can sometimes be painful and can get infected.

In more advanced cases this can progress to a pathological jaw fracture (break in the jaw) which can be disfiguring and make eating difficult. Sometimes the skin overlying the jaw becomes infected too and breaks down, leaving a fistula (communication) between the mouth and the skin of the face or neck.

ORN can be a devastating complication for patients and can have a big impact on quality of life, causing pain and difficulty in eating and swallowing.

The options for managing ORN include medications such as pentoxyfilline which can sometimes help to improve the situation, or simple surgical debridement – removing the dead pieces of bone to encourage healing.

For more advanced cases, surgery can be performed to remove the affected part of bone and reconstruct with free flap bone grafts usually taken from the lower leg (Fibular), shoulder blade (Scapular) or hip (DCIA – deep circumflex iliac artery). This surgery is particularly challenging in the context of previous radiotherapy.

Luke and Alastair have extensive experience of successfully performing complex reconstructions and are also core members of the highly regarded ORN multi-disciplinary team at Guys hospital.

Good decision making is vitally important especially in a complex area such as the management of Osteoradionecrosis, in order to achieve the best outcomes possible. Sometimes patients would like the reassurance of a second opinion and the opportunity to discuss treatment options with leading specialists.

The team at Head + Neck Surgery London regularly provide second opinions, and would be happy to arrange this if required.