A modified protocol for early treatment of osteomyelitis and osteoradionecrosis of the mandible.

BACKGROUND: The treatment of osteoradionecrosis (ORN) and early chronic osteomyelitis (COM) of the mandible and maxilla is controversial. Hyperbaric oxygen (HBO) at two to three times the atmospheric pressure at sea level can result in tissue oxygen tension of almost 400 mmHg. Herewith HBO increases oxygen supply in hypoxic tissue, thus inducing fibroblastic proliferation and capillary formation. METHODS: From 1981 to 1991, we used a monoplace chamber and since 1992, we have also had a multiplace chamber for HBO treatment. Hyperbaric oxygen was given at 2.5-2.8 atmosphere absolute pressure (ATA) for 90-120 minutes, once per day. The patients had five to 10 preoperative and five to seven postoperative sessions. Surgical therapy consisted of decortication of the affected bone, subsequently covered with a free periosteal transplant from the tibia. RESULTS: Thirty-six patients with ORN and 33 with COM of the mandible and maxilla was treated with this protocol. The median follow-up time in this material is 34 months, with a minimum of 10 months. Thirty-six ORN patients (92%) and 26 COM patients (79%) have remained symptom-free after the first treatment period. Three failed ORN patients were successfully treated with a free microvascular flap. The seven failed COM patients have been retreated, and five of them have occasional clinical symptoms. CONCLUSIONS: Hyperbaric oxygen is a promising adjunct to surgery in the treatment of mandibular and maxillary ORN and COM. Using this protocol, the necessary HBO treatment sessions have been reduced from earlier protocols, without adverse effect on the outcome.

A modified protocol to treat early osteoradionecrosis of the mandible.

Hyperbaric oxygen (HBO) increases oxygen availability to hypoxic tissues thereby inducing fibroblastic proliferation and capillary formation in bone and soft tissue. From 1981 to 1991 we used a monoplace hyperbaric chamber, and since 1992 a multiplace chamber, for HBO treatments. HBO was given at 2.5-2.8 atm abs for 90-120 min, once per day. We used five to seven preoperative and five to seven postoperative sessions. Altogether, 17 patients with osteoradionecrosis (ORN) of the mandible or maxilla were treated with surgery and HBO. Surgical therapy consisted of decortication of the affected bone that was subsequently covered with a free periosteal transplant from the tibia. The shortest follow-up time is 18 mo. Sixteen patients have remained symptom free after the first treatment period. One case was a failure in the early protocol but was successfully treated using a free microvascular flap. It is concluded that HBO is a promising adjunct to surgery in treating mandibular or maxillary ORN.