The role of hyperbaric oxygen in osteoradionecrosis-a prophylactic insight.

BACKGROUND Osteoradionecrosis (ORN) is an uncommon and debilitating consequence of head and neck radiotherapy and hyperbaric oxygen therapy (HBOT) has been advocated for prophylaxis prior to performing dentoalveolar procedures. The aim of this study was to evaluate a prophylactic HBOT protocol and describe the outcomes of susceptible individuals. METHODS A retrospective audit of adults who attended the Oral and Maxillofacial Surgery department at the Royal Adelaide Hospital (South Australia) who received dental extractions with a history of radiotherapy to the jaws from 2008 to 2020. Data including demographic information and outcomes of osteoradionecrosis and delayed healing was recorded. RESULTS A total of 121 individuals were eligible for case note review; 68.6% of individuals were male and 55.4% were aged over 67 years. Osteoradionecrosis occurred in 9.1% of individuals and delayed healing for 3.3%; fifteen individuals (12.4%) were unable to complete the HBOT protocol. The individuals who were diagnosed with ORN had a significant association with age (P = 0.006) and binary analysis showed alcohol consumption to be a significant predictor. CONCLUSIONS Prophylactic HBOT protocol had a lower proportion of individuals diagnosed with ORN and those who were diagnosed were more likely to be younger males and have current alcohol consumption.

[1]  E. Carlson,et al.  American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaw-2022 Update. , 2022, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[2]  C. von Buchwald,et al.  Hyperbaric oxygen treatment of mandibular osteoradionecrosis: Combined data from the two randomized clinical trials DAHANCA-21 and NWHHT2009-1. , 2021, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[3]  J. Wang,et al.  Chinese group expert consensus on diagnosis and clinical management of osteoradionecrosis of the mandible. , 2020, International journal of oral and maxillofacial surgery.

[4]  R. Shaw,et al.  HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): A Randomized Controlled Trial of Hyperbaric Oxygen to Prevent Osteoradionecrosis of the Irradiated Mandible After Dentoalveolar Surgery. , 2019, International journal of radiation oncology, biology, physics.

[5]  M. Bulsara,et al.  Protocol for prospective randomised assessor-blinded pilot study comparing hyperbaric oxygen therapy with PENtoxifylline+TOcopherol± CLOdronate for the management of early osteoradionecrosis of the mandible , 2019, BMJ Open.

[6]  A. Kolokythas,et al.  Management of osteoradionecrosis of the jaws with pentoxifylline-tocopherol: a systematic review of the literature and meta-analysis. , 2019, International journal of oral and maxillofacial surgery.

[7]  P. Brennan,et al.  Pentoxifylline - a review of its use in osteoradionecrosis. , 2017, The British journal of oral & maxillofacial surgery.

[8]  M. Batstone,et al.  Radiotherapy‐associated dental extractions and osteoradionecrosis , 2017, Head & neck.

[9]  M. McGurk,et al.  Prophylactic use of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of the head and neck. , 2016, The British journal of oral & maxillofacial surgery.

[10]  N. Hampson,et al.  Hyperbaric oxygen therapy for late radiation tissue injury. , 2005, The Cochrane database of systematic reviews.

[11]  N. Samman,et al.  Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. , 2011, International journal of oral and maxillofacial surgery.

[12]  D. Buchbinder,et al.  Paradigm shifts in the management of osteoradionecrosis of the mandible. , 2010, Oral oncology.

[13]  N. Ghazali,et al.  Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. , 2008, The British journal of oral & maxillofacial surgery.

[14]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[15]  J. Lefaix,et al.  Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: A phase II trial , 2005, Head and Neck.

[16]  J. Lefaix,et al.  The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. , 2004, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[17]  U. Mende,et al.  Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients--a report of a thirty year retrospective review. , 2003, International journal of oral and maxillofacial surgery.

[18]  Y. Yamazaki,et al.  Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy , 2003, Head & neck.

[19]  H. Schwartz,et al.  Osteoradionecrosis of the Mandible: Scientific Basis for Clinical Staging , 2002, American journal of clinical oncology.

[20]  A. Goss,et al.  Hyperbaric oxygen in the prevention of osteoradionecrosis of the jaws. , 1999, Australian dental journal.

[21]  J. Epstein,et al.  Osteonecrosis: study of the relationship of dental extractions in patients receiving radiotherapy. , 1987, Head & neck surgery.

[22]  R. P. Johnson,et al.  Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. , 1985, Journal of the American Dental Association.

[23]  Ryan S. Lee,et al.  The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience. , 2017, Oral oncology.

[24]  N. Samman,et al.  Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. , 2012, Oral surgery, oral medicine, oral pathology and oral radiology.

[25]  C. Regaud.  Sur la necrose des os atteints par un processus cancereux et traites par les radiations , 1922 .