Introduction Osteoradionecrosis (ORN) is a well recognized complication following radiotherapy
for head and neck tumors. ORN in the mandible with an incidence between 10 and 15 %
is common, but the temporal bone is a very rare site of ORN.
Case report We present a case of an 90 year old man, who underwent repeated surgery and radiotherapy
for an auricle carcinoma on the left side. About one year after extensive surgery
an repeated radiotherapy (total amount in 2013 an 2014: 102 Gy) for recurrent carcinoma
of the skull base a small skin defekt on the mastoid occured. In the next weeks he
developed typical symptoms of ORN with otorrhea, hearing loss an otalgia. He received
conservative therapy, including topical antibiotics and long-term antibiosis. Because
of local necrosis of the bone he received local debridement. In the next years bony
necrosis increased and 3 years after radiation facial nerve paralysis occured. A debridement
with plastic reconstruction was rejected. About 5 years after radiothearpy he was
hospitalised with intermittent significant bleeding due to an erosion of the internal
carotid artery (ICA). With a pressure bandage the bleeding could be temporarily controlled.
He subsequently unterwent angiography in which the skull-based ICA could be identified
as the source of bleeding. An endovascular stent-graft was immediately delivered to
stop the bleeding. Due to the old age, the patient died of cardiovascular failure
shortly afterwards.
Conclusion ORN of the temoral bone is a very rare complication of radiation, that can be life-threatening
due to its proximity to the large vessels. This case shows a potential management
of such a uncommon complication.
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