Hyperbaric
oxygen therapy (HBO) was first proposed as a treatment for cancer
and other conditions in the 1960s. At the time, research studies did
not achieve any reproducible results, which engendered much
skepticism among medical personnel. This skepticism even extended to
HBO's use in treating clinical conditions that it had previously
been shown to help. It was not until the 1970's that surgeons of the
head and neck region came to recognize the value of hyperbaric
oxygen in treating damage of the maxilla and mandible occurring
during radiation treatments.
Research into
this therapy has since shown HBO to be effective when used in
addition to conventional therapies for the prevention and treatment
of osteoradionecrosis. There is also evidence to suggest that HBO
may be helpful as a therapy for soft tissue injury caused by
radiation, as well as restoring tissues and cells damaged by
chemotherapy and radiation treatments. It has been in the field of
treating osteoradionecrosis that hyperbaric oxygen therapy has seen
some of its most dramatic successes.
When
osteoradionecrosis develops, tissue destruction devolves into
breakdown of overlying tissues and symptomatic destruction of bone.
During this process, the response to antibiotics can be poor. In
many cases, the situation can be improved with the use of HBO
therapy. Hyperbaric oxygen has been shown to be more effective than
penicillin. Patients being treated with penicillin typically show a
significantly higher rate of necrosis than those being treated with
hyperbaric oxygen, with only five to thirty percent of patients able
to expect remission of ORN through conservative therapy. HBO therapy
is especially beneficial for high-risk patients, such as irradiated
patients requiring tooth extraction.
Hyperbaric
treatment allows more oxygen to reach the damaged areas, and helps
prevent tissues from dying from lack of blood and oxygen flow. The
therapy is painless, and it is capable of producing a wide range of
effects, including increased oxygen delivery to injured tissue,
greater blood vessel formation, advanced wound healing, improved
infection control, preservation of damaged tissue, elimination of
toxic substances, and reduced effects from toxic substances.
Hyperbaric oxygen therapy appears to assist in salvaging tissue
damaged by radiation therapy by stimulating angioneogenesis in
tissue that is even marginally viable. In reconstructive surgery
involving irradiated tissue, HBO treatment prior to surgery can help
promote a well-vascularized wound, enhancing healing and the
reconstructive process.
HBO therapy acts
through both mechanical (pressure) and physiological (oxygen)
components. Reports of early administration of hyperbaric oxygen,
alone without appropriate aggressive surgical debridement, were
disappointing, showing only an eight percent response rate. HBO was
thus used as an adjunct to conservative therapy, and, in this new
supportive role, showed excellent response rates. In a protocol
developed by Marx, 58 patients received HBO treatments followed by
debridement. All 58 patients studied had resolution of symptoms,
with good results on long-term follow up, and others have now
corroborated these results.
Health care
workers were able to deliver two to three times the amount of oxygen
that can be provided by breathing 100% oxygen, as opposed to the
twenty-one percent that we usually breath. This high-pressure dose
of oxygen offers significant therapeutic benefits. Under such
circumstances, repair of tissue damaged by high doses of ionizing
radiation is facilitated.
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