Hyperbaric oxygen therapy is a common adjunct therapy that is employed in my clinic for various indications, including diabetic foot ulcer healing, refractory osteomyelitis and radiation injury. In the case of radiation injury and specifically osteoradionecrosis (ORN) of the mandible the Marx protocol for treatment is considered the standard of care. Dr Marx recognized that the reason surgical and non-surgical treatments of ORN failed is that they did not address the basic pathophysiology of the disease process. Adding hyperbaric treatment to the management of the ORN patient enhances wound healing through both the topical bacteriostatic effects of oxygen but also enhances wound healing through stimulation of vascular proliferation in the diseased bone and mucosa.

The classic protocol as described in this paper is 100% FiO2 at a pressure of 2.4 atmospheres absolute pressure (ATA) for 90 minutes, daily for 5 days per week. The treatment was delivered in 3 phases 30 HBOT treatments, if there was clinical response then the patient went on for a total of 60 treatments. If no clinical improvement was noted the patient then went on to a sequestrectomy, and then continued treatment up to 60 treatments post-sequestrectomy. If clinical response was not noted then they advanced to a resection and an additional 30 treatments of HBOT with bone graft reconstruction.

In this original publication 58 cases of ORN were successfully treated resolving pain, retaining mandibular continuity, restoring mandibular function and intact mucosa.

Marx RE, A New Concept in the Treatment of Osteoradionecrosis. J. Oral Maxilofac Surg 1983, 41:351-7