Osteoradionecrosis of the exenterated orbit

Area of Science:

• Oncology
• Oral and Maxillofacial Surgery
• Radiology

Background:

• Osteoradionecrosis (ORN) affects approximately 2% of head and neck cancer patients treated with radiotherapy.
• It is characterized by devitalized irradiated bone that fails to heal for at least three months, excluding local malignancy.
• Commonly affects the mandible, but can occur in the maxilla, temporal bone, clavicle, and vertebrae.

Observation:

• This report details two cases of ORN occurring after orbital exenteration and subsequent radiotherapy.
• ORN can arise spontaneously or be triggered by secondary trauma.
• Radiotherapy-induced endarteritis and osteoblast dysfunction impair bone vascularity and healing capacity.

Findings:

• The study presents a rare, previously unreported complication of radiotherapy in the context of orbital exenteration.
• Diagnostic tools like CT and MRI are crucial for differentiating ORN from other conditions such as malignancy recurrence or infection.
• Clinical management of ORN is challenging, underscoring the importance of preventative strategies.

Implications:

• Early detection of ORN with a high index of suspicion is vital for successful conservative management.
• Clinicians should be vigilant for bone exposure or delayed healing in patients with a history of radiotherapy.
• This case series emphasizes the need for awareness regarding ORN as a potential complication in orbital radiotherapy patients.