The extent of manifestation of the osteonecrotic process after radiation therapy of malignant neoplasms of the head and neck is currently unknown and little studied. The same can be said about the choice of methods and surgical techniques in this category of patients. We believe that the choice of method is based on the determination of the true size of the defect, the search for the optimal source of complete blood supply as well as the presence of restrictions on the general somatic status. In osteoradionecrosis clinically significant changes occur in the facial vessels, which is reflected both in the bone tissue and in soft tissue structures that correspond not only to irradiation area but also to compromised blood supply area. The study identified histopathological changes in the irradiated vessels, soft tissues and bones of the facial skeleton in 20 of patients. Biopsy findings were correlated with ultrasound and tomographic examination data. Based on the findings summary the methods are proposed for examining patients and choosing the best surgical treatment methods for maximal possible rehabilitation.