Osteonecrosis (ONJ) of the head and neck is a spectrum of bone damaging disease and is preventable in many cases. Although commonly due to adverse sequelae of radiotherapy, bisphosphonate use has been recently implicated as an independent risk factor. Tissue hypoxia, hypovascularity, and hypocellularity occur. Osteoclast function, as well as collagen synthesis and production are impaired, which can lead to a nonhealing wound. ONJ will ultimately develop in up to 10 percent of patients and is a serious and devastating complication. The mandible, larynx, and temporal bone are most often involved. This course will discuss the pathophysiology, diagnosis, and therapeutic modalities (medical and surgical) to prevent and treat ONJ. Hyperbaric oxygen therapy can increase tissue oxygenation, and enhance neovascularization and wound healing. The scientific basis for its use, and its utility with planned debridement, sequestrectomy, and/or resection will be delineated. Optimal reconstructive techniques will be described for each situation. Adjunctive therapies (Vitamin E, Pentoxifylline, Fluoride treatments) and the role of allied professionals, particularly in the area of prevention, will be addressed. Finally, a systematic management scheme to treat this potentially debilitating disease for each site will be provided with an emphasis on early detection and appropriate decision-making.