Osteoradionecrosis

What is osteoradionecrosis?

Osteoradionecrosis (ORN) is bone death that is caused by radiation. It is a side effect that can happen if you have had radiation to your head and neck area. ORN often affects your jaw bones. Radiation harms the healthy gums that cover your jawbone. The bone becomes exposed. Because the bone isn’t covered, it is more likely to become infected or unable to heal.

What are the symptoms of ORN?

Some of the most common symptoms of ORN are:

• Pain.
• Swelling.
• Sores or ulcers.
• Trouble opening your mouth (trismus).

What causes ORN?

Radiation exposure can cause hypovascularization, or not enough blood flow to the bones. Radiation can harm and sometimes destroy small blood vessels that supply the jawbone and nearby tissues with oxygen and nutrients. The more radiation you get, the more likely you are to get ORN.

Can I prevent ORN?

You can’t prevent ORN, but there are some ways to lower your risk. Before you have radiation to your head and neck area, see your dentist for your routine cleaning, have any teeth removed that could be a problem in the future, and start daily fluoride treatments.

During and after radiation to your mouth area, practice good mouth care, continue daily fluoride treatments, limit sugar in your diet, visit your dentist for regular cleanings, and take care of any new dental issues right away.

When should I contact my provider?

If you have had radiation to your head and neck area and have new symptoms like swelling, pain, or sores, call your provider right away. ORN can happen months or even years after your radiation treatments. If you need dental work done, you should talk with your radiation oncologist first. Having a tooth removed could cause trauma to your jawbone, which can worsen ORN and cause infection.

How is ORN treated?

Treatment depends on how serious your ORN is. You may need:

• Antibiotics: At the first sign of infection, most providers will order you an antibiotic. This will control and treat the infection.
• Hyperbaric Oxygen Therapy (HBO): HBO is the use of pure oxygen to help the healing of blood vessels and tissues. This treatment allows you to breathe in higher levels of oxygen to help speed up your body’s healing process.
• Surgery: Surgery can be used to remove the dead bone. The type of surgery you need depends on how severe the ORN is. You may need to have bone and tissue taken from another part of your body to rebuild what was removed. In some cases, hyperbaric oxygen therapy is given before or after the surgery is done.

ORN is a serious side effect that can happen after radiation treatment for head and neck cancers. You and your provider will work together to decide the best way to prevent or treat your ORN.