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Osteoradionecrosis of the skull base

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Abstract

Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT leads to the destruction of vasculature in radiated tissue causing hypoxia and tissue necrosis. ORN can occur in any bone, but bones with naturally poor blood supply appear to be more susceptible. Bones of the skull base are susceptible, with ORN occurring in the anterior, central, and lateral skull base. Risk factors include cancer type and location, radiation dose, and a variety of patient factors. Patients often present with pain, bleeding, and foul odor and are typically found to have exposed and necrotic bone. Treatment options vary depending on the severity, but typically include pentoxifylline and vitamin E as well as surgical debridement, with less evidence supporting hyperbaric oxygen therapy. Recognition and prompt treatment of ORN will allow for improved patient outcomes.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA

    John P. Leonetti & Jeffrey R. Weishaar

  2. Loyola Stritch School of Medicine, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA

    David Gannon

  3. Department of Radiation Oncology, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA

    Grant A. Harmon & Alec Block

  4. Department of Neurological Surgery, The Loyola Center for Cranial Base Tumors, Loyola University of Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA

    Douglas E. Anderson

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  1. John P. Leonetti
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  2. Jeffrey R. Weishaar
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Correspondence to John P. Leonetti.

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Leonetti, J.P., Weishaar, J.R., Gannon, D. et al. Osteoradionecrosis of the skull base. J Neurooncol 150, 477–482 (2020). https://doi.org/10.1007/s11060-020-03462-3

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  • DOI: https://doi.org/10.1007/s11060-020-03462-3

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