Stanford Head and Neck Center

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Reconstruction and Rehabilitation Program

Radiation Damage and Osteoradionecrosis of the Head and Neck

Radiation therapy is often a critical component in the treatment of head and neck cancer. Radiation works by depositing energy in tumor cells that eventually leads to their destruction. Unfortunately, to deliver this energy to the tumor, the radiation beams have to pass through normal tissues, often skin and bone. Despite the highly targeted Intensity Modulated Radiation Therapy (IMRT) utilized by radiation oncologists, the dose delivered to normal tissues can sometimes lead to problems in the future.

Radiation affects normal skin and bone by decreasing the available blood supply and causing changes in the tissue akin to scarring. When this process occurs in the skin and soft tissues, it can lead to skin breakdown or fibrosis. When this occurs in bone, it decreases the vascular supply to bone, rendering it more susceptible to infection and exposure. These increased stresses on the bone can cause part of it to die, leading to osteoradionecrosis. The components of this word describe the disease process: osteo (bone) - radio (secondary to radiation therapy) - necrosis (non-viable tissue), literally non-viable bone secondary to prior radiation treatment.

Once bone becomes non-viable, the body reacts to it by trying to expel that bone from the jaw.  However, when this cannot happen, the area can become repetitively infected, leading to facial swelling, pain, and necessitating courses of antibiotics. In a very small set of patients, these infections and necrotic bone can eventually lead to a fracture of the jaw, or an opening from the bone out toward the neck (fistula).

a) the fracture b) area to be resected c) how the fibula will fit into the defect once the bone segments have been manipulated

Fractures occur when an entire of segment of bone is damaged, or when there is too little bone left to withstand the tremendous forces created by chewing. In all of these cases, a surgical referral is necessary to removal the non-viable bone, and to reconstruct the jaw if necessary.

At Stanford, we are proud to offer state-of-the-art management of complications from radiation therapy. Vasu Divi, MD, is a head and neck-trained microvascular surgeon who specializes in the management of osteoradionecrosis. Dr. Divi brings his extensive experience with jaw reconstructions and his focus on maximizing quality of life to every patient consultation.

Treatment of radiation related sequela should be provided in a multidisciplinary environment. Our team includes dentists, oral surgeons, speech and swallow rehabilitation, and prosthodontics. We strive to ensure that winning your battle against cancer doesn’t mean losing your quality of life.

Stanford OHNS Head & Neck Microvascular Surgeon

Appointments

Appointments for evaluation can be made by contacting: 
(650) 723 - 5400