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.

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

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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.

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Reviewed by health care specialists at UCSF Medical Center.

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UCSF Clinics & Centers


Facial Plastic and Reconstructive Surgery
2320 Sutter St., Suite 102
San Francisco, CA 94115
Phone: (415) 353-9500
Fax: (415) 885-7785
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Helen Diller Family Comprehensive Cancer Center

Head and Neck Cancer
1825 Fourth St., Fourth Floor
San Francisco, CA 94158
Phone: (415) 885–7528
Fax: (415) 885–7711
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Oral and Maxillofacial Surgery
707 Parnassus Ave., Suite D-1201
San Francisco, CA 94143
Phone: (415) 476-1316
Fax: (415) 712-0617
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