Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones

This paper reviews all 17 cases of facial bone osteoradionecrosis (ORN) which were treated in Adelaide, South Australia, in a nine-year period (1987-1996). This was 1.2% of all cases of head and neck cancer treated with radiotherapy (RT). Fourteen cases received treatment following the MARX principles of staging and the protocols of hyperbaric oxygen plus or minus surgery. The three exclusions were two patients who died of recurrent cancer before treatment was complete and one who declined treatment. The eleven cases of mandibular ORN occurred within a few years of the initial RT treatment. All except one occurred after surgical trauma, with dental extractions being the factor in nine cases. All responded to HBO, with or without surgery depending on stage. The three cases of temporal bone ORN were all of late spontaneous onset. All were stage I and all responded to HBO alone. This study shows that the incidence of ORN in Adelaide is low. probably through use of conservative doses of RT and good preventative protocols. The treatment with HBO plus or minus surgery was effective.