Osteoradionecrosis is a serious side effect of radiation therapy for head and neck cancers. It can take years for symptoms to develop. Treatments include hyperbaric oxygen (HBO) therapy, reconstructive surgery and medical management. Early treatment is key.
Osteoradionecrosis (ORN) is a condition in which bone has died due to radiation exposure. It’s a side effect of radiation therapy for cancer in your head or neck. ORN can develop months or years after radiation treatment for cancer. Symptoms of osteoradionecrosis include pain, swelling and sores.
ORN most commonly affects your lower jaw (mandibular osteoradionecrosis), but it can also occur in your upper jaw (maxillary osteoradionecrosis), the front of your spine (vertebral osteoradionecrosis) or in any other bone exposed to significant radiation.
In rare cases, ORN can affect your skull. This is a potentially fatal condition.
Radiation damages blood supply to your bone. This makes it harder to heal from infection, trauma or surgery (like a tooth extraction). Without a properly working blood supply, your bone and surrounding tissue:
Your jaw is particularly at risk because of unavoidable bone exposure to radiation during head and neck cancer treatment. Natural bacteria in your mouth further increase your risk for ORN.
In your mouth, radiation damage can cause:
Approximately 4% to 8% of people with head and neck cancers develop osteoradionecrosis, according to the American Head & Neck Society.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Symptoms of osteoradionecrosis include:
Radiation therapy to your head and neck may result in osteoradionecrosis. People who receive radiation doses greater than 60 grays (Gy) are more likely to develop osteoradionecrosis. (The gray is a unit used to measure radiation.)
You have a higher risk of developing jaw osteoradionecrosis if you:
Osteoradionecrosis may develop several years after radiation therapy for head and neck cancers.
Osteoradionecrosis often occurs several years after your initial radiation treatment. If your healthcare provider suspects ORN, they’ll visually examine your head and neck. They’ll likely contact your radiation oncologist to find out the total dose of radiation you received during treatment.
To confirm your diagnosis, your healthcare provider may recommend:
Osteoradionecrosis treatment depends on the extent and severity of your condition. Early intervention is key. The sooner you undergo treatment, the better your long-term outlook. There are nonsurgical and surgical treatments that can help.
Nonsurgical treatments for osteoradionecrosis include:
Surgical treatments for osteoradionecrosis include:
You can’t always prevent ORN. But before you begin head and neck radiation therapy, your healthcare provider will talk with you about ways to reduce your risk for osteoradionecrosis.
Prior to radiation therapy, you should:
During and after radiation therapy, you should:
In most cases, osteoradionecrosis develops slowly. Several years may go by before you notice any symptoms.
Osteoradionecrosis isn’t curable. But many people can manage the condition with treatment. In fact, early intervention can halt the progression of ORN in 96% of cases.
The prognosis of someone with osteoradionecrosis varies depending on the location of the affected area and the extent of bone death. Typically, the smaller the area of affected bone, the better your chance of healing.
Some people heal well and have no complications. Others may develop osteomyelitis (infection of the bone) or even fractures.
If you’ve had head and neck radiation therapy in the past and start to notice pain, swelling or ulcers, you should contact your healthcare provider right away. They can confirm whether you have osteoradionecrosis and begin any necessary treatment promptly.
If you or a loved one has an osteoradionecrosis diagnosis, you may want to ask these questions:
A note from Cleveland Clinic
Osteoradionecrosis (ORN) is a serious side effect of head and neck radiation therapy. It can take years to develop symptoms. ORN isn’t curable, but it’s manageable with treatment. Outcomes vary depending on the location, extent and severity of bone death. If you have pain, swelling, exposed bone or other osteoradionecrosis symptoms, contact a healthcare provider right away. They can recommend treatment and find ways to manage your condition.
Last reviewed by a Cleveland Clinic medical professional on 03/02/2023.
Learn more about our editorial process.