ROLE OF HYPERBARIC-OXYGEN THERAPY IN THE MANAGEMENT OF MANDIBULAR OSTEORADIONECROSIS

Hyperbaric oxygen (HBO) has been used as a tool in the management of o steoradionecrosis (ORN). However, it has not been conclusively proven to be of benefit. The precise role and guidelines for its use also hav e not been clearly defined. This report retrospectively analyzes 41 pa tients treated at the Hyperbaric Chamber Unit at the Toronto Hospital (Toronto General Division) with proven mandibular ORN from 1980 to 198 5. The results show that 83% of the patients had a significant improve ment with HBO therapy, judged by at least a 50% decrease in the size o f the exposed bone, closing of the fistulous tract, or complete relief of symptoms. Within the group of patients who were significantly impr oved, 15% showed complete resolution of ORN. Seven (17%) of the patien ts did not benefit from the HBO. All seven patients had radiological e vidence of dead bone. Based on these observations, the following concl usions can be made: 1. HBO is of benefit in the management of ORN. 2. Patients with ORN may be divided into two groups: mild and severe. 3. Cases of mild ORN will heal with HBO alone, but, in severe ORN, surger y is necessary to remove dead bone. 4. All patients with ORN should re ceive dental evaluation, local wound care, and a strict oral hygiene r egimen. Diseased teeth should be removed prior to radiotherapy. Subseq uently, any teeth that became abscessed should be extracted in conjunc tion with prophylactic HBO. Antibiotics play an ancillary role in the management of ORN. For patients who have received radiation to the man dible, the authors propose regular follow-up in order to detect ORN at a time when HBO can arrest the disease.