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Mayland et al. Plast Aesthet Res 2021;8:62 Plastic and
DOI: 10.20517/2347-9264.2021.38
Aesthetic Research

Review Open Access

A review of advanced head and neck
osteoradionecrosis

Erica J. Mayland, Larissa Sweeny

Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Science Center - New Orleans, New
Orleans, LA 70809, USA.
Correspondence to: Dr. Larissa Sweeny, Department of Otolaryngology-Head and Neck Surgery, Louisiana State University
Health Science Center - New Orleans, New Orleans, LA 70809, USA. E-mail: lswee1@lsuhsc.edu
How to cite this article: Mayland EJ, Sweeny L. A review of advanced head and neck osteoradionecrosis. Plast Aesthet Res
2021;8:62. https://dx.doi.org/10.20517/2347-9264.2021.38
Received: 20 Apr 2021 First Decision: 19 Jul 2021 Revised: 19 Jul 2021 Accepted: 22 Oct 2021 Published: 5 Dec 2021

Academic Editors: Matthew Spector, Marten Basta Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Osteoradionecrosis (ORN) of the head and neck can be a devastating complication following radiation therapy.
ORN is associated with pain, chronic infection, and non-healing wounds. Radiation fibrosis, chronic infection, fistula
formation, and necrotic tissues can make treatment challenging. The following review article is a narrative on the
management of advanced head and ORN.

Keywords: Head and neck reconstruction, free flap, osteoradionecrosis

INTRODUCTION
The majority of patients with advanced head and neck cancer will receive radiation as part of their
[1]
treatment . For a subset of patients, radiation treatment has devasting side effects on the surrounding non-
cancerous tissues. One of the most crippling outcomes is the development of osteoradionecrosis (ORN) in
the head and neck region. These cases can range from mildly symptomatic areas of exposed bone to
pathological fractures, often leaving patients with disabling symptoms. The current understanding of ORN
pathophysiology suggests a progression of hypovascular-hypoxic-hypocellular tissue. Changes in the
metabolic homeostasis following radiation eventually progress to a state of hypoxia and hypovascularity.
[2]
This ultimately leads to tissue breakdown and a non-healing wound .

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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