Using Hyperbaric Oxygen Therapy to Prevent Osteoradionecrosis in Irradiated Jaws

Tooth extraction is a common cause of developing osteoradionecrosis (ORN) in the irradiated jaws. The hyperbaric oxygen therapy (HBOT) is used to prevent ORN by applying steep oxygen gradients to irradiated jaws/tissues making them less hypocellular, hypovascular and hypoxic. Objective: To review the outcome, through a retrospective clinical audit, of the use of prophylactic hyperbaric oxygen therapy (HBOT) to prevent the development of osteoradionecrosis (ORN) as a result of dental extractions in patients who had received head and neck irradiation between 2003-2006. An additional aim was to assess the incidence of reported vision changes following HBOT. Methods: Information collected included patient age, gender, site and type of tumor, radiation dose, time lapse between radiotherapy and dental extraction and HBOT protocol used in patients. This was obtained from records at GreenlaneClinicalCentre, Auckland. Diagnosis of ORN, time taken to heal following extraction, pain intensity and incidence of visual changes was obtained through a telephone interview with patients using a standardized quality of life questionnaire. Results: 26 out of 29 patients (90%) treated with HBOT in an attempt to prevent ORN were interviewed. Of the 26, 25 (96%) were successfully treated with only one (4%) developing ORN. An additional two patients who received head and neck irradiation and had their dental extractions without prophylactic HBOT were identified. Both patients (100%) developed ORN. Ethical considerations precluded the use of a larger control group. Nine of the 26 (35%) patients developed vision changes which lasted for a maximum of eight weeks post HBOT as predicted. Conclusion: The study indicated that it is beneficial to use HBOT prophylactically to prevent the development of ORN while carrying out traumatic dental work particularly extractions, following radiotherapy to the head and neck. Vision changes following 20th HBOT treatment are transient and, if present, last for maximum of 8 weeks.