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Did You Know? Mandibular Osteoradionecrosis (ORN)

July 19, 2019

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A Recognized, Evidence-Based Indication
for Hyperbaric Oxygen Therapy

What is Mandibular Osteoradionecrosis (ORN)?

Osteoradionecrosis (ORN) means death of bone as a result of radiation. Patients who have had high-dose radiation for treatment of head and neck cancers may develop ORN. The most common site for developing ORN is the mandible, although osteoradionecrosis can occur in other parts of the body. Hyperbaric oxygen therapy used for early bone loss, or for treatment of advanced ORN as an adjunct to surgery, can markedly improve a patient’s quality of life both clinically and functionally.

Radiation injury is caused by obliterative endarteritis, which can be chronically induced by radiation exposure. Blood vessels affected by this condition have reduced blood/oxygen-carrying capacity as their lumens are severely narrowed. However, radiation scientists more recently have found, and believe that, radiation injury is also caused by fibrosis and depletion of parenchymal and stem cells. Further research is ongoing.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy protocol

The rationale for using hyperbaric oxygen (HBO) therapy is that the increased tissue oxygen tension promotes an immediate increase of oxygen in the diseased blood vessels and will eventually stimulate the growth of new capillaries. Research shows significant efficacy in utilizing HBO therapy as a treatment in both early and advanced cases of ORN.

HBO is used for mandibular ORN for:

  • treatment of early ORN in a person who has had radiation to the head and/or neck and is scheduled for dental extraction
  • treatment of advanced ORN.

Patients with early ORN who need diseased teeth extracted from radiated jaw bone and/or require debridement of diseased jaw bone may be referred to HBO for the Marx protocol, as long as there is documentation of bony resorption. The Marx protocol is a series of hyperbaric treatments that revolve around a surgical schedule. The Marx protocol requires 30 hyperbaric treatments. The first 20 treatments are done before the patient’s surgery. Hyperbaric therapy is then paused until the surgery and the final ten treatments are completed immediately after the patient’s surgery (usually resumes within one or two days of surgery). It is critical that there is minimal delay between the patient’s surgery and 21st hyperbaric oxygen treatment in order to mitigate the surgical insult to the mandible.

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