Radiation osteitis, radiation necrosis, irradiation osteomyelitis, avascular bone necrosis
Definitions
Radiation-induced injury to temporal bone
Localized (more common): Limited to external auditory canal (EAC)
Diffuse: Involves mastoid septations and middle ear cavity (MEC), possibly skull base
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Herr MW et al: Radiation necrosis of the lateral skull base and temporal bone. Semin Plast Surg. 34(4):265-71, 2020
Yuhan BT et al: Osteoradionecrosis of the temporal bone: an evidence-based approach. Otol Neurotol. 39(9):1172-83, 2018
Lambert EM et al: Effects of radiation on the temporal bone in patients with head and neck cancer. Head Neck. 38(9):1428-35, 2016
Glicksman JT et al: Pentoxifylline-tocopherol-clodronate combination: a novel treatment for osteoradionecrosis of the temporal bone. Head Neck. 37(12):E191-3, 2015
Kammeijer Q et al: Treatment outcomes of temporal bone osteoradionecrosis. Otolaryngol Head Neck Surg. 152(4):718-23, 2015
Lee EW et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 94(1):18-9, 2015
Phillips DJ et al: Radiation-induced necrosis of the temporal bone: diagnosis and Management. Otol Neurotol. 36(8):1374-7, 2015
Ahmed S et al: CT findings in temporal bone osteoradionecrosis. J Comput Assist Tomogr. 38(5):662-6, 2014
Sharon JD et al: Osteoradionecrosis of the temporal bone: a case series. Otol Neurotol. 35(7):1207-17, 2014
Delanian S et al: Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int J Radiat Oncol Biol Phys. 80(3):832-9, 2011
Morrissey D et al: Incidence of osteoradionecrosis of the temporal bone. ANZ J Surg. 81(12):876-9, 2011
Leonetti JP et al: Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors. Otol Neurotol. 31(4):656-9, 2010
Benlier E et al: Massive osteoradionecrosis of facial bones and soft tissues. J BUON. 14(3):523-7, 2009
Metselaar M et al: Osteoradionecrosis of tympanic bone: reconstruction of outer ear canal with pedicled skin flap, combined with hyperbaric oxygen therapy, in five patients. J Laryngol Otol. 123(10):1114-9, 2009
Xu YD et al: Surgical treatment of osteoradionecrosis of the temporal bone in patients with nasopharyngeal carcinoma. J Laryngol Otol. 122(11):1175-9, 2008
Nason R et al: Bacterial biofilms may explain chronicity in osteoradionecrosis of the temporal bone. Otol Neurotol. 28(8):1026-8, 2007
Ang E et al: Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg. 56(2):92-9, 2003
Linskey ME et al: Radiation exposure of normal temporal bone structures during stereotactically guided gamma knife surgery for vestibular schwannomas. J Neurosurg. 98(4):800-6, 2003
Linskey ME et al: Radiation tolerance of normal temporal bone structures: implications for gamma knife stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 57(1):196-200, 2003
Armour A et al: Late radiation side-effects in three patients undergoing parotid irradiation for benign disease. Clin Oncol (R Coll Radiol). 12(6):403-8, 2000
Pathak I et al: Temporal bone necrosis: diagnosis, classification, and management. Otolaryngol Head Neck Surg. 123(3):252-7, 2000
Tsang WS et al: Osteoradionecrosis of the temporal bone in nasopharyngeal carcinoma after radiotherapy: a case report. Ear Nose Throat J. 79(2):94-5, 2000
Vudiniabola S et al: Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones. Int J Oral Maxillofac Surg. 29(6):435-8, 2000
Hao SP et al: Systematic management of osteoradionecrosis in the head and neck. Laryngoscope. 109(8):1324-7; discussion 1327-8, 1999
Pfreundner L et al: Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys. 44(4):777-88, 1999
Meiteles L et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 77(1):56-7, 1998
Lustig LR et al: Radiation-induced tumors of the temporal bone. Am J Otol. 18(2):230-5, 1997
Nishimura R et al: MR evaluation of radiation otomastoiditis. Int J Radiat Oncol Biol Phys. 39(1):155-60, 1997
Fong RS et al: Pediatric sensorineural hearing loss after temporal bone radiation. Am J Otol. 16(6):793-6, 1995
Rudge FW: Osteoradionecrosis of the temporal bone: treatment with hyperbaric oxygen therapy. Mil Med. 158(3):196-8, 1993
Thornley GD et al: Osteoradionecrosis of the temporal bone. J Otolaryngol. 8(5):396-400, 1979
Ramsden RT et al: Osteoradionecrosis of the temporal bone. J Laryngol Otol. 89(9):941-55, 1975
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Osteoradionecrosis (ORN)
Synonyms
Radiation osteitis, radiation necrosis, irradiation osteomyelitis, avascular bone necrosis
Definitions
Radiation-induced injury to temporal bone
Localized (more common): Limited to external auditory canal (EAC)
Diffuse: Involves mastoid septations and middle ear cavity (MEC), possibly skull base
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Herr MW et al: Radiation necrosis of the lateral skull base and temporal bone. Semin Plast Surg. 34(4):265-71, 2020
Yuhan BT et al: Osteoradionecrosis of the temporal bone: an evidence-based approach. Otol Neurotol. 39(9):1172-83, 2018
Lambert EM et al: Effects of radiation on the temporal bone in patients with head and neck cancer. Head Neck. 38(9):1428-35, 2016
Glicksman JT et al: Pentoxifylline-tocopherol-clodronate combination: a novel treatment for osteoradionecrosis of the temporal bone. Head Neck. 37(12):E191-3, 2015
Kammeijer Q et al: Treatment outcomes of temporal bone osteoradionecrosis. Otolaryngol Head Neck Surg. 152(4):718-23, 2015
Lee EW et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 94(1):18-9, 2015
Phillips DJ et al: Radiation-induced necrosis of the temporal bone: diagnosis and Management. Otol Neurotol. 36(8):1374-7, 2015
Ahmed S et al: CT findings in temporal bone osteoradionecrosis. J Comput Assist Tomogr. 38(5):662-6, 2014
Sharon JD et al: Osteoradionecrosis of the temporal bone: a case series. Otol Neurotol. 35(7):1207-17, 2014
Delanian S et al: Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int J Radiat Oncol Biol Phys. 80(3):832-9, 2011
Morrissey D et al: Incidence of osteoradionecrosis of the temporal bone. ANZ J Surg. 81(12):876-9, 2011
Leonetti JP et al: Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors. Otol Neurotol. 31(4):656-9, 2010
Benlier E et al: Massive osteoradionecrosis of facial bones and soft tissues. J BUON. 14(3):523-7, 2009
Metselaar M et al: Osteoradionecrosis of tympanic bone: reconstruction of outer ear canal with pedicled skin flap, combined with hyperbaric oxygen therapy, in five patients. J Laryngol Otol. 123(10):1114-9, 2009
Xu YD et al: Surgical treatment of osteoradionecrosis of the temporal bone in patients with nasopharyngeal carcinoma. J Laryngol Otol. 122(11):1175-9, 2008
Nason R et al: Bacterial biofilms may explain chronicity in osteoradionecrosis of the temporal bone. Otol Neurotol. 28(8):1026-8, 2007
Ang E et al: Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg. 56(2):92-9, 2003
Linskey ME et al: Radiation exposure of normal temporal bone structures during stereotactically guided gamma knife surgery for vestibular schwannomas. J Neurosurg. 98(4):800-6, 2003
Linskey ME et al: Radiation tolerance of normal temporal bone structures: implications for gamma knife stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 57(1):196-200, 2003
Armour A et al: Late radiation side-effects in three patients undergoing parotid irradiation for benign disease. Clin Oncol (R Coll Radiol). 12(6):403-8, 2000
Pathak I et al: Temporal bone necrosis: diagnosis, classification, and management. Otolaryngol Head Neck Surg. 123(3):252-7, 2000
Tsang WS et al: Osteoradionecrosis of the temporal bone in nasopharyngeal carcinoma after radiotherapy: a case report. Ear Nose Throat J. 79(2):94-5, 2000
Vudiniabola S et al: Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones. Int J Oral Maxillofac Surg. 29(6):435-8, 2000
Hao SP et al: Systematic management of osteoradionecrosis in the head and neck. Laryngoscope. 109(8):1324-7; discussion 1327-8, 1999
Pfreundner L et al: Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys. 44(4):777-88, 1999
Meiteles L et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 77(1):56-7, 1998
Lustig LR et al: Radiation-induced tumors of the temporal bone. Am J Otol. 18(2):230-5, 1997
Nishimura R et al: MR evaluation of radiation otomastoiditis. Int J Radiat Oncol Biol Phys. 39(1):155-60, 1997
Fong RS et al: Pediatric sensorineural hearing loss after temporal bone radiation. Am J Otol. 16(6):793-6, 1995
Rudge FW: Osteoradionecrosis of the temporal bone: treatment with hyperbaric oxygen therapy. Mil Med. 158(3):196-8, 1993
Thornley GD et al: Osteoradionecrosis of the temporal bone. J Otolaryngol. 8(5):396-400, 1979
Ramsden RT et al: Osteoradionecrosis of the temporal bone. J Laryngol Otol. 89(9):941-55, 1975
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