From Volume 49, Issue 1, January 2022 | Pages 64-67
Osteoradionecrosis (ORN) is a late complication of radiotherapy treatment for head and neck cancer. In the past two decades there have been significant changes in the mode by which radiation is delivered and it was assumed this would lead to a reduction, or even elimination, of this complication. Paradoxically, ORN rates may have risen. This article provides a summary of the current understanding and approach to ORN.
Osteoradionecrosis (ORN) was first reported almost a century ago.1 To date, numerous approaches have been taken to prevent it from occurring or to treat it once established. This includes improvements in radiotherapy (RT) delivery, pre-treatment dental assessment and continuing dental care. However, ORN continues to occur, in part due to a change in the profile of head and neck cancer (HNC) patients. This article highlights some of the key changes occurring in the modern era that impact on the development of ORN.
Although ORN is a well-recognized condition, no international agreed definition exists. In the UK, the most commonly accepted ORN description is ‘an area of exposed bone present for longer than 2 months in a previously irradiated field, in the absence of recurrent tumour’ (Figure 1).2 The definition is incomplete in that it ignores both maxillary ORN and non-exposed ORN. A commonly used and simple classification is one proposed by Notani et al3 (Table 1 and Figure 2).
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