Signs and Symptoms

Most people don’t notice symptoms for months or years following radiation treatment. We typically identify the signs following the procedure or any other major procedure performed by head and neck cancer patients.

Certain circumstances increase the likelihood of developing osteoradionecrosis. These include receiving radiation in combination with chemotherapy, smoking while receiving treatment, and the size and location of the cancer being treated.

The symptoms include:

• The jaw has a limited range of motion.
• Pain that develops when you are at rest
• A facial or jaw swelling
• Exposition of the mandible, or maxilla. These are the lower and upper jaws.

Complications

Osteoradionecrosis (ORN) is a bone necrosis that can occur as a complication of radiation therapy. It most often affects the mandible (jawbone), but can also occur in other bones. ORN typically develops several months or even years after radiation therapy has been completed. The exact cause of ORN is not fully understood, but it is thought to be due to a combination of tissue hypoxia (lack of oxygen), radiation-induced damage to blood vessels, and inflammatory reactions. Treatment for ORN can be challenging, and may include surgery, hyperbaric oxygen therapy, and/or radiation therapy. In some cases, ORN can lead to significant morbidity and even mortality. As such, it is important for patients who have received radiation therapy to be aware of the potential risks of developing ORN and be in contact with specialists who can explore the possibility of it occurring beforehand.

What are The Ways to Diagnose It?

Early diagnosis of osteoradionecrosis (ORN) is difficult because the early clinical signs and symptoms are often subtle and nonspecific. In addition, there is no gold standard diagnostic test for ORN. The best approach to diagnosis is a combination of clinical suspicion, radiographic findings, and histopathologic confirmation. Clinical suspicion should be aroused by a patient’s history of radiation therapy, particularly if there has been a recent treatment break or change in the radiation dose or field.

Additionally, patients with known risk factors for ORN, such as preexisting dental disease, smoking, diabetes, or immunosuppression, should be closely monitored for signs and symptoms of the condition. Radiographic findings suggestive of ORN include bone loss, soft tissue necrosis, and bone marrow edema. However, these findings are often seen in other conditions, so they must be interpreted in the context of the clinical picture. Histopathologic confirmation of diagnosis is achieved through biopsy of the affected area. However, this is not always possible or practical. As a result, the diagnosis of ORN oftentimes must be made based on clinical suspicion and radiographic findings in combination.