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Review
. 2017 Mar;22(3):343-350.
doi: 10.1634/theoncologist.2016-0298. Epub 2017 Feb 16.

The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline

Ahmed Sultan  1   2 , Glenn J Hanna  3 , Danielle N Margalit  4   5 , Nicole Chau  3 , Laura A Goguen  6 , Francisco M Marty  7 , Guilherme Rabinowits  3 , Jonathan D Schoenfeld  4   5 , Stephen T Sonis  1   2   8 , Tom Thomas  6 , Roy B Tishler  4   5 , Nathaniel S Treister  1   2   8 , Alessandro Villa  1   2   8 , Sook-Bin Woo  1   2   8 , Robert Haddad  3   8 , Hani Mawardi  9   8
Affiliations
Review

The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline

Ahmed Sultan et al. Oncologist. 2017 Mar.

Erratum in

Abstract

Background: Osteoradionecrosis of the jaw (ORN) is an infrequent yet potentially devastating complication of radiation therapy to the head and neck region. Treatment options include antimicrobial therapy, local sequestrectomy, resection, and the use of hyperbaric oxygen (HBO). Published data on ORN are difficult to compare because of the lack of a universally accepted classification and staging system, and the literature on the use of HBO to either prevent or successfully manage ORN is controversial and inconclusive. Therefore, we aimed to establish a standard approach for using HBO at our institution.

Materials and methods: A literature search was conducted of articles published in the English language between January 1980 and January 2016. Retrieved articles were evaluated by two independent reviewers. Isolated case reports, abstracts, case series, review articles, and cohort studies without a control group were excluded; summary data were extracted from the remaining studies. A panel of experts from Head and Neck Oncology and Oral Medicine from the Dana-Farber Cancer Institute and Brigham and Women's Hospital reviewed the summary data and established multidisciplinary guidelines on the use of HBO for the prevention and management of ORN.

Results: Seven studies were evaluated and reviewed by the multidisciplinary panel. There was no consistent evidence in support of HBO for either the prevention or management of ORN.

Conclusion: Based on the available evidence and expert opinion, routine use of HBO for the prevention or management of ORN is not recommended and is rarely used at our institution. The Oncologist 2017;22:343-350 IMPLICATIONS FOR PRACTICE: The Division of Head and Neck Oncology of Dana-Farber/Brigham and Women's Cancer Center does not recommend the routine use of HBO for the prevention or management of ORN. Adjunctive HBO may be considered for use on a case-by-case basis in patients considered to be at exceptionally high risk who have failed conservative therapy and subsequent surgical resection.

Keywords: Hyperbaric oxygen; Management; Osteoradionecrosis; Prevention.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of literature search and study selection.
See this image and copyright information in PMC

References

    1. Nabil S and Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: A systematic review. Int J Oral Maxillofac Surg 2011;40:229–243. - PubMed
    1. Wong JK, Wood RE, McLean M. Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:16–21. - PubMed
    1. Chrcanovic BR, Reher P, Sousa AA et al. Osteoradionecrosis of the jaws–a current overview–part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 2010;14:3–16. - PubMed
    1. Reuther T, Schuster T, Mende U 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. Int J Oral Maxillofac Surg 2003;32:289–295. - PubMed
    1. Margalit DN, Losi SM, Tishler RB et al. Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations. J Oncol Pract 2015;11:151–154. - PubMed

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