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Temporal Bone Osteoradionecrosis
Hilda E. Stambuk, MD
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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

                                          1. Glicksman JT et al: Pentoxifylline-tocopherol-clodronate combination: a novel treatment for osteoradionecrosis of the temporal bone. Head Neck. 37(12):E191-3, 2015
                                          2. Kammeijer Q et al: Treatment outcomes of temporal bone osteoradionecrosis. Otolaryngol Head Neck Surg. 152(4):718-23, 2015
                                          3. Lee EW et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 94(1):18-9, 2015
                                          4. Phillips DJ et al: Radiation-induced necrosis of the temporal bone: Diagnosis and Management. Otol Neurotol. 36(8):1374-7, 2015
                                          5. Ahmed S et al: CT findings in temporal bone osteoradionecrosis. J Comput Assist Tomogr. 38(5):662-6, 2014
                                          6. Sharon JD et al: Osteoradionecrosis of the temporal bone: a case series. Otol Neurotol. 35(7):1207-17, 2014
                                          7. 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
                                          8. Morrissey D et al: Incidence of osteoradionecrosis of the temporal bone. ANZ J Surg. 81(12):876-9, 2011
                                          9. Leonetti JP et al: Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors. Otol Neurotol. 31(4):656-9, 2010
                                          10. Benlier E et al: Massive osteoradionecrosis of facial bones and soft tissues. J BUON. 14(3):523-7, 2009
                                          11. 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
                                          12. 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
                                          13. Nason R et al: Bacterial biofilms may explain chronicity in osteoradionecrosis of the temporal bone. Otol Neurotol. 28(8):1026-8, 2007
                                          14. Ang E et al: Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg. 56(2):92-9, 2003
                                          15. 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
                                          16. 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
                                          17. 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
                                          18. Pathak I et al: Temporal bone necrosis: diagnosis, classification, and management. Otolaryngol Head Neck Surg. 123(3):252-7, 2000
                                          19. 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
                                          20. 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
                                          21. Hao SP et al: Systematic management of osteoradionecrosis in the head and neck. Laryngoscope. 109(8):1324-7; discussion 1327-8, 1999
                                          22. Pfreundner L et al: Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys. 44(4):777-88, 1999
                                          23. Meiteles L et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 77(1):56-7, 1998
                                          24. Lustig LR et al: Radiation-induced tumors of the temporal bone. Am J Otol. 18(2):230-5, 1997
                                          25. Nishimura R et al: MR evaluation of radiation otomastoiditis. Int J Radiat Oncol Biol Phys. 39(1):155-60, 1997
                                          26. Fong RS et al: Pediatric sensorineural hearing loss after temporal bone radiation. Am J Otol. 16(6):793-6, 1995
                                          27. Rudge FW: Osteoradionecrosis of the temporal bone: treatment with hyperbaric oxygen therapy. Mil Med. 158(3):196-8, 1993
                                          28. Thornley GD et al: Osteoradionecrosis of the temporal bone. J Otolaryngol. 8(5):396-400, 1979
                                          29. 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

                                                                                  1. Glicksman JT et al: Pentoxifylline-tocopherol-clodronate combination: a novel treatment for osteoradionecrosis of the temporal bone. Head Neck. 37(12):E191-3, 2015
                                                                                  2. Kammeijer Q et al: Treatment outcomes of temporal bone osteoradionecrosis. Otolaryngol Head Neck Surg. 152(4):718-23, 2015
                                                                                  3. Lee EW et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 94(1):18-9, 2015
                                                                                  4. Phillips DJ et al: Radiation-induced necrosis of the temporal bone: Diagnosis and Management. Otol Neurotol. 36(8):1374-7, 2015
                                                                                  5. Ahmed S et al: CT findings in temporal bone osteoradionecrosis. J Comput Assist Tomogr. 38(5):662-6, 2014
                                                                                  6. Sharon JD et al: Osteoradionecrosis of the temporal bone: a case series. Otol Neurotol. 35(7):1207-17, 2014
                                                                                  7. 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
                                                                                  8. Morrissey D et al: Incidence of osteoradionecrosis of the temporal bone. ANZ J Surg. 81(12):876-9, 2011
                                                                                  9. Leonetti JP et al: Temporal bone osteoradionecrosis after surgery and radiotherapy for malignant parotid tumors. Otol Neurotol. 31(4):656-9, 2010
                                                                                  10. Benlier E et al: Massive osteoradionecrosis of facial bones and soft tissues. J BUON. 14(3):523-7, 2009
                                                                                  11. 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
                                                                                  12. 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
                                                                                  13. Nason R et al: Bacterial biofilms may explain chronicity in osteoradionecrosis of the temporal bone. Otol Neurotol. 28(8):1026-8, 2007
                                                                                  14. Ang E et al: Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg. 56(2):92-9, 2003
                                                                                  15. 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
                                                                                  16. 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
                                                                                  17. 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
                                                                                  18. Pathak I et al: Temporal bone necrosis: diagnosis, classification, and management. Otolaryngol Head Neck Surg. 123(3):252-7, 2000
                                                                                  19. 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
                                                                                  20. 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
                                                                                  21. Hao SP et al: Systematic management of osteoradionecrosis in the head and neck. Laryngoscope. 109(8):1324-7; discussion 1327-8, 1999
                                                                                  22. Pfreundner L et al: Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys. 44(4):777-88, 1999
                                                                                  23. Meiteles L et al: Osteoradionecrosis of the temporal bone. Ear Nose Throat J. 77(1):56-7, 1998
                                                                                  24. Lustig LR et al: Radiation-induced tumors of the temporal bone. Am J Otol. 18(2):230-5, 1997
                                                                                  25. Nishimura R et al: MR evaluation of radiation otomastoiditis. Int J Radiat Oncol Biol Phys. 39(1):155-60, 1997
                                                                                  26. Fong RS et al: Pediatric sensorineural hearing loss after temporal bone radiation. Am J Otol. 16(6):793-6, 1995
                                                                                  27. Rudge FW: Osteoradionecrosis of the temporal bone: treatment with hyperbaric oxygen therapy. Mil Med. 158(3):196-8, 1993
                                                                                  28. Thornley GD et al: Osteoradionecrosis of the temporal bone. J Otolaryngol. 8(5):396-400, 1979
                                                                                  29. Ramsden RT et al: Osteoradionecrosis of the temporal bone. J Laryngol Otol. 89(9):941-55, 1975