Osteoradionecrosis (ORN) is a condition that occurs when radiation exposure damages the blood supply to your bone, killing bone cells and preventing them from regenerating normally. ORN most commonly occurs months or years after radiation therapy for cancer and is most often found in the lower jawbone after treatment for head and neck cancers.
UPMC experts specialize in advanced treatments for ORN, providing care that slows the progression of the disorder and enhances quality of life.
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What Is ORN?
Osteoradionecrosis (ORN) is a condition that occurs when radiation exposure damages the blood supply to your bone, killing bone cells and preventing them from regenerating normally. ORN most commonly occurs months or years after radiation therapy for cancer and is most often found in the lower jawbone after treatment for head and neck cancers.
What are the types of ORN?
ORN can affect any bone exposed to significant amounts of radiation.
However, it most commonly occurs in your:
- Lower jawbone.
- Skull (rare).
- Spine.
- Upper jawbone.
How common is ORN?
According to the American Head & Neck Society, ORN is rare. It affects 4% to 8% of people who have had radiation therapy to treat head and neck cancer.
What causes ORN?
ORN is caused by exposure to radiation during radiation therapy to treat cancer. Although radiation beams are precisely aimed at the tumor during radiation therapy, surrounding bones and tissues are also exposed to radiation. Radiation exposure to healthy bone can damage its blood supply, causing a lack of oxygen that leads to bone cell necrosis (death).
ORN risk factors
Risk factors for ORN include:
- Having a condition that affects your blood vessels, such as peripheral artery disease, diabetes, or obesity.
- Having a condition that weakens your immune system.
- Having an injury to your jaw or other trauma after radiation therapy, such as a tooth extraction.
- Having dental issues, such as cavities, dry mouth, gum disease, or poor oral hygiene.
- Higher radiation exposure.
- Radiation exposure to your head or neck.
- Smoking.
Complications of ORN
ORN complications include:
- Exposed bone.
- Infection.
- Nonhealing ulcers or sores.
- Pain and swelling.
How can I prevent ORN?
You may not be able to prevent ORN. However, before you start radiation therapy, your doctor can recommend strategies to reduce your risk.
What Are the Signs and Symptoms of ORN?
Symptoms of ORN may include:
- Exposed bone in your mouth or through your skin.
- Fractures.
- Muscle tightness.
- Nonhealing wounds.
- Numbness or tingling.
- Pain.
- Problems with teeth alignment.
- Sores or ulcers on your gums, neck, or outer jaw.
- Swelling.
- Ulceration (breaks in the skin or tissue).
When should I see a doctor about my ORN symptoms?
If you have ORN symptoms, you should schedule an appointment with your doctor right away. Getting early treatment may prevent the progression of your condition and reduce your risk of complications.
How Do You Diagnose ORN?
To diagnose ORN, your doctor will ask you about your symptoms and medical history and perform a physical exam. Your doctor may also order imaging tests.
What to expect during your visit
If your doctor suspects ORN, they will:
- Perform a physical exam.
- Ask you about your symptoms.
- Order imaging tests.
Tests to diagnose ORN
Tests to help your doctor diagnose ORN may include:
- Biopsy — A procedure to take a small sample of abnormal bone or tissue for analysis in a lab.
- CT scan — A test that creates images of your body's organs, bones, and tissues.
- MRI — To locate the ORN area and assist doctors in creating a treatment plan.
- PET/CT — An imaging test that can identify necrotic tissue.
ORN prognosis
Dead bone can’t be saved, but getting early treatment can prevent the progression of ORN and reduce your risk of complications.
Can ORN be cured?
ORN is a treatable condition, especially when it only affects a small section of bone. Early treatment usually results in better outcomes. Your doctor will discuss your expected prognosis with you.
How long is life expectancy with radiation necrosis?
Severe ORN may affect your life expectancy. However, other factors, such as your age, overall health, the location of the affected bone, and treatment success, can also affect survival. Your doctor will discuss your estimated life expectancy with you.
How Do You Treat ORN?
The goals of ORN treatment are to stop the progression of the condition, promote wound healing, and reduce the risk of complications. Treatment options depend on the location of your ORN and may include:
Medication for ORN
Your doctor may prescribe antibiotics to treat infection or other medications to improve blood flow to your bone.
Systemic hyperbaric oxygen therapy for ORN
Hyperbaric oxygen therapy (HBOT) involves using oxygen at a level higher than atmospheric pressure to deliver a greater-than-normal amount of oxygen to your body's tissues. Your blood carries this oxygen throughout your body, stimulating the release of substances called growth factors and stem cells, which strengthen your body’s natural wound-healing mechanisms and promote healing.
Surgery for ORN
Our wound care team has experienced orthopaedic, vascular, podiatric, and plastic surgeons who can assess and treat all types of nonhealing wounds.
Our interdisciplinary approach means your surgical team consults with your primary care physician and other wound-healing experts. We will create a comprehensive, customized treatment plan, including post-surgical wound care, to help you return to your daily life as soon as possible.
Surgical treatments for ORN may include:
Surgical debridement
Surgical debridement is the removal of infected or nonviable bone to speed healing. It can be a primary treatment or one step in a treatment plan, such as debridement of your wound in combination with HBOT.
Free flap reconstruction surgery
Free flap reconstruction surgery is a procedure that involves harvesting a graft composed of blood vessels, tissue, and bone from another part of your body and transplanting it into the diseased area. Surgeons often use a graft from your thigh for this procedure because of its rich blood supply.
Bone removal and replacement
This procedure involves removing dead bone and replacing it with a free flap. Bone removal and replacement is a complex procedure that requires a lengthy hospital stay and recovery.
Why Choose UPMC for ORN Care?
When you choose UPMC for ORN care, you will receive:
- Access to world-class wound care and surgical expertise — Our world-renowned experts treat ORN using the latest approaches and techniques.
- A full range of treatment options — We offer advanced care to manage ORN while reducing your risk of complications.
- Multidisciplinary care — We partner with orthopaedic, head and neck, vascular, podiatric, and plastic surgeons to provide comprehensive ORN care that optimizes your recovery and quality of life.
