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Osteoradionecrosis (ORN) is an unusual complication from radiation therapy to the head and neck that unfortunately results in bone death. Radiation therapy is used to kill cancer cells, but the treatment also harms healthy cells at the same time.

If enough of the healthy cells in your jaw bones are damaged, it can result in a decrease of blood or essential nutrients to that area. Our bones require a constant supply of blood for nourishment and support so if this supply is compromised, it can lead to the death of that section of bone.

Once a section of the jaw dies it begins to deteriorate and weaken. Minor trauma such as dental surgery or other procedures to the head and neck may exacerbate the weakness and lead to further pain. The jaw bones can become exposed in the mouth or through the facial skin and the weakness may even lead to jaw fracture.

Mild or moderately damaged bone is usually treated by oral surgery, but the most severe cases may require bone replacement surgery. Surgeons in the UCSF Facial Plastic and Reconstructive Surgery Clinic work in conjunction with other surgeons at UCSF, including oral and maxillofacial or head and neck cancer surgeons, to remove and repair the most severely damaged areas of the jaw.

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Signs & symptoms

Many people don't experience symptoms for months or even years after radiation treatment. Symptoms are usually identified after a subsequent dental surgery or other major procedure in head and neck cancer survivors.

Certain factors increase the risk of developing osteoradionecrosis, such as receiving both radiation and chemotherapy, smoking during treatment, and the location and size of the tumor being treated.

Symptoms include:

  • Limited range of motion of jaw
  • Pain that occurs at rest
  • Jaw or facial swelling
  • Exposure of the mandible or maxilla, which are the upper and lower jaw


You will be diagnosed with osteoradionecrosis by an oral and maxillofacial or head and neck cancer surgeon. To rule out recurrence of your disease, your doctor may order imaging such as:


Depending on the stage of osteoradionecrosis, your doctor may recommend that the dead bone be removed and that you undergo reconstructive surgery to return normal facial contour and function.

The primary reconstructive procedure is microvascular head and neck reconstruction.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

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