The presentation of ORN ranges from superficial, slowly progressive
bone erosion, to pathological fracture. Patients often present with signs and symptoms of pain, drainage, fevers, and fistula
formation. It rarely occurs in patients who have been exposed
to a radiation dose less than 60 Gy and it is more common when
brachytherapy is utilized.1,2 Dental and periodontal disease, dental
extractions, surgery, and trauma are frequently associated with the
onset of ORN.3 ORN has also been reported to occur spontaneously.
There are a number of risk factors which contribute to, and are
associated with, the development of ORN (Table 1). Although the
risk of developing ORN is thought to be higher following treatment
with combined chemo-radiation, to date there have been no studies
which have conclusively shown an increase in the incidence of
ORN in this patient population.4