Radiation therapy plays a significant role in the contemporary
management of head and neck malignancies. It is used in a variety
of different treatment protocols, in combination with chemotherapy
and surgery. Osteoradionecrosis (ORN) is usually a late complication
of radiation exposure, occurring when irradiated bone becomes
devitalized. It is classically defined as exposed bone through an
opening in the overlying skin or mucosa, persisting as a non-healing
wound for three months or more.1 However, we have recently
encountered a patient with a severe case of ORN, with a pathologic
fracture but no evidence of bone exposure.