Osteoradionecrosis of the temporal bone: assessment and management

Osteoradionecrosis of the temporal bone is a rare but potentially serious complication of radiation therapy in the head and neck. It is most commonly associated with treatment of nasopharyngeal carcinoma but is also found after radiation therapy for lesions of the oropharynx, parotid, paranasal sinuses, and jugular foramen. Typically, osteoradionecrosis is a late complication presenting many years after radiation insult. Secondary infection promotes further bone necrosis and accounts for the persistent and indolent nature of the disease. Osteoradionecrosis may lead to chronic otomastoiditis, meningitis, lateral sinus thrombosis, and intracranial abscess. Evaluation of the patient with otologic complaints and a history of locoregional radiation involves a combination of history, physical examination, and radiographic imaging. Treatment includes a combination of medical and surgical interventions and typically requires long-term therapy. The role of hyperbaric oxygen has not been adequately defined.