Osteoradionecrosis (ORN) and soft tissue necrosis is the cause of significant morbidity in head and neck cancer survivors. An evidence-based approach of the treatment of ORN continues to evolve with both surgical and non-surgical management. For advanced ORN, the gold-standard treatment is surgical resection of the hypoxic and hypovascular necrotic bone with immediate reconstruction with vascularized tissue into the irradiated fields. However, there are special considerations for this type of intervention given that previously irradiated and/or operated environments offer unique challenges. Similarly, soft tissue necrosis after radiation can be a diagnostic challenge, as tumor recurrence is always a consideration. Recognizing when to treat can also be problematic as it is difficult to determine if and when these ulcers will heal without surgical intervention with vascularized tissue. Experts will review the evidence and share their personal experience of operating in these distinct conditions. Additionally, this session will also evaluate and review the conservative management options and review recently published protocols for early ORN. This educational panel will highlight the challenges of recognizing and treating radiation-induced complications in head and neck cancer.