Abstract
This study aimed to understand how hyperbaric oxygen therapy can act in the treatment of osteoradionecrosis of the jaws in patients with head and neck cancer. A total of 266 publications were found. After applying the inclusion and exclusion criteria, 19 articles were selected. Osteoradionecrosis is a condition with great potential for bone destruction, and therefore, many methods for treatment have been vehemently studied. Although the mechanism of action of hyperbaric oxygen therapy is not fully understood, it is known that the physiochemistry that drives the action is a result of two factors: 100% inspired oxygen and exposure to high atmospheric pressure. In addition, oxygen when present in larger quantities in the body can act to heal necrotic regions, oxygenating regions where hypoxia and hypoperfusion have occurred. However, this therapy is not totally innocuous and has significant issues for the patient, among them, the limitation of its access, and with this, the cost for oxygen therapy is very high. The negative impact that osteoradionecrosis has on oncology patients can be seen, and how hyperbaric therapy can act in the treatment of necrosis caused by oncotherapy in patients with head and neck cancer, due to its numerous effects on oxidative metabolism. In contrast, it is necessary to correctly evaluate the indication of the treatment, because the therapy has relevant adverse effects that deserve attention.
Highlights
The damage caused by oncotherapy in the head and neck region has a decisive impact on the quality of life of patients, where the effects generated have a direct impact on the stomatognathic system
Hyperbaric oxygen therapy can be recommended for stage I and II mandibular osteoradionecrosis, and for selected cases of stage III ORN, such as in patients who have poor surrounding soft tissue condition
Our large single center experience supports the efficacy of hyperbaric oxygen therapy for osteoradionecrosis of the maxillary bone
Summary
The damage caused by oncotherapy in the head and neck region has a decisive impact on the quality of life of patients, where the effects generated have a direct impact on the stomatognathic system. Cancer treatment is effective, high doses of radiation therapy can induce many side effects, such as osteoradionecrosis, a serious and debilitating complication caused by radiation therapy after treatment of head and neck cancer (Gavriel et al, 2017). The pathogenesis of this condition is the result of fibrosis of the blood vessels in the irradiated area, which makes the tissue hypovascular, hypocellular and hypoxic, so that bone sequestration occurs and there may be exposure through the overlying skin or mucosa, persisting as a non-healing wound for 3 months or more. In more complex cases, in which conservative treatment no longer shows expressive results, surgical approaches are required, such as total or partial resection and reconstruction with bone graft (Shaw et al, 2018)
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