Effectiveness of Hyperbaric Oxygen Therapy in the Management of Osteoradionecrosis of the Jaw: A Systematic Review

Osteoradionecrosis (ORN) of the jaws is the most dangerous long-term side effect of head and neck radiation therapy that can significantly affect the quality of life of the patients. In ORN of the jaw, the bone within the radiation field becomes devitalized and gets exposed via the overlying skin or mucosa, which remains unhealed. Hyperbaric oxygen therapy (HBOT) is used as an adjunctive therapy along with surgical debridement for the management of ORN of the jaws. HBOT promotes angiogenesis, neovascularization, fibroblast and osteoblast proliferation, and collagen production. However, the benefit of HBOT in improving the healing of tissues in patients with ORN remains controversial because of low evidence. The present systematic review aimed to compare the available data on the efficacy of HBOT on the healing of ORN of the jaw. Databases like PubMed, Scopus, Cochrane, Science Direct, Lilac, and Web of Science were searched without any date filter to obtain the relevant articles. A total of six articles met the eligibility criteria and were further processed for data extraction. Two retrospective studies observed that HBOT combined with surgical debridement promoted wound healing in patients with early stages of ORN of the jaws. Similarly, a prospective study reported that prophylactic HBOT reduced the risk of the development of ORN of the jaws following surgery to irradiated jaws. In contrast, three randomized controlled trials (RCTs) reported that HBOT did not improve the healing outcome of patients with advanced lesions of ORN of the jaws. Based on the scope of this review, we concluded that the routine use of HBOT for the prevention or management of ORN of the jaws is not recommended. Adjunctive HBOT may be considered in patients who have failed conservative therapy and subsequent surgical resection and are regarded to be at high risk.