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Saturday, December 18, 2010

Hyperbaric oxygen treatment: is it working?

Irradiation treatment for cancer of the head and neck can cause permanently reduction in the blood supply to the mandibular and maxillary (jaw) bones. The mandible is more frequently affected. This places treated individuals at risk of developing bone necrosis (osteoradionecrosis ) especially after dental manipulations such as tooth extraction, surgery, and implant placement. The risk of developing bone necrosis depends on the amount of radiation delivered. When possible it is advisable that if needed tooth repair, extraction or restoration is done before radiation.
Hyperbaric oxygen therapy (HBO) has been suggested as a beneficial therapeutic maneuver in head and neck cancers patients who developing osteoradionecrosis after radiation treatment. HBO is a medical treatment during which the entire body is placed in an airtight chamber at increased atmospheric pressure and the patient breathes 100% oxygen.
Theoretically HBO has the potential of preventing and improving osteoradionecrosis because it increases oxygen supply to the affected area which enhances collagen synthesis and vascular density. The schedules for prevention and treatment of osteoradionecrosis generally include 20 to 30 preoperative HBO sessions followed by 10 postoperatively.
A recent review suggested that HBO may be beneficial for those with late radiation tissue injury to the head and neck, and promote healing of irradiated sockets after dental extraction (Bennett et al. Cochrane Database Syst Rev 2005; :CD005005). Unfortunately, the available data are conflicting, and the benefit of using HBO to prevent or treat osteoradionecrosis of the jaw in irradiated patients is uncertain. Because randomized trials have not been done, questions persist about the ultimate utility of this approach.