Management of Skull Base Osteoradionecrosis

Osteoradionecrosis of the skull base (SB-ORN) is a serious potentially lethal complication after radiotherapy in the head and neck region and is therefore considered one of the most challenging clinical entities among skull base lesions. Management options includes nasal irrigation, medications such as systemic antibiotics and anti-inflammatory drugs, hyperbaric oxygen therapy, and surgical debridement. Despite these efforts treatment outcomes are associated with a poor prognosis. Recent studies have shown an increased disease control rate with a more aggressive surgical approach including sequestrectomy. One of the main factors associated with poor prognosis is involvement of the internal carotid artery near the skull base. Spontaneous carotid rupture is frequently associated with death and/or severe morbidity and also poses risk of profuse bleeding during surgery. In this article we will deliver a comprehensive review of SB-ORN, including pathophysiology, clinical features, and an update in treatment strategy.