Etiology • A serious complication of tumoricidal doses of radiation to
the head and neck, usually > 60 Gy (6,000 rads) • Radiation produces damage to the microvasculature, permit-
ting a hypoxic state, which, in turn, leads to a hypocellular bony environment.
• Minor damage to the irradiated bone produces a nonhealing wound, forming dead bone—necrosis.
Clinical Presentation • Usually affects the mandible • Bone pain • Exposed necrotic bone within radiation portal • External fistula formation • Pathologic fracture
the head and neck, usually > 60 Gy (6,000 rads) • Radiation produces damage to the microvasculature, permit-
ting a hypoxic state, which, in turn, leads to a hypocellular bony environment.
• Minor damage to the irradiated bone produces a nonhealing wound, forming dead bone—necrosis.
Clinical Presentation • Usually affects the mandible • Bone pain • Exposed necrotic bone within radiation portal • External fistula formation • Pathologic fracture
Radiographic Findings • Irregular zones of mixed radiopacity and radiolucency • Separation of nonvital bone (sequestrum) from remaining
viable bone
Diagnosis • Radiographic and clinical features • Biopsy results show nonvital bone.
Differential Diagnosis • Metastatic tumor • Locally recurrent tumor • Osteomyelitis • Osteosarcoma • Radiation-induced sarcoma
Treatment • After biopsy, débridement of bone preceded and followed by
hyperbaric oxygen therapy • If necessary, resection and reconstruction
• Necessary tooth extraction and elimination of focal infection within radiation portal 21 days prior to treatment
• Excellent preventive dental care
Prognosis • Guarded
• Excellent preventive dental care
Prognosis • Guarded