Osteoradionecrosis and Hyperbaric Oxygen
Medical-Grade Hyperbaric oxygen therapy (HBOT) is a safe adjunct treatment and prevents the development of osteonecrosis of the jaw (ORN), a radiotherapy-exposed bone disease in which bone structure deteriorates. The treatment provides patients with 100% pure oxygen to breathe in a high-pressure chamber. Hyperbaric increases full mucosal coverage of the jaw in patients with osteoradionecrosis of the jaw. HBOT is safe, as adverse events are very few and transitory. The therapy improves osteoradionecrosis healing outcomes after the surgical removal of necrotic bone, as compared to standard care.
How Medical-Grade Hyperbaric Oxygen Works
Increased Tissue Oxygenation
HBOT constitutes oxygen delivery at greater than one atmosphere of pressure (ATM) in a chamber or pressurized vessel to increase tissue oxygen partial pressure (Po2) above that achieved by breathing 100% oxygen at sea level. This increased oxygen availability helps counteract the tissue hypoxia commonly associated with osteoradionecrosis and creates an environment that supports healing.
Physiologic Healing Response
Clinical HBOT is a medical treatment designed to promote physiologic changes caused by the elevation of tissue Po2, which promotes healing through several molecular pathways, reducing edema and inflammation, augmenting microbial killing, invoking stem cell mobilization, vasculogenesis—the process by which new blood vessels are formed de novo (from scratch) during embryonic development—and ultimately promoting tissue repair.
Reactive Nitrogen and Oxygen Species
Elevation of Po2 also promotes increased local concentrations of reactive nitrogen species, as it provides substrate for nitric oxide synthase (O2 and l-arginine), which simultaneously produces reactive oxygen species such as superoxide. These biological responses contribute to the healing mechanisms that make HBOT an effective adjunctive therapy for osteoradionecrosis.
Cellular and Molecular Effects
Dose-dependent actions of reactive nitrogen species and reactive oxygen species on molecular processes cause allosteric effects on regulatory enzymes, transcription factors, and genes that can promote healing in otherwise nonresponsive tissues. These cellular and molecular effects are particularly valuable in radiation-damaged tissues where natural healing processes have been compromised.
Vasculogenesis and Tissue Regeneration
HBOT promotes vasculogenesis, as shown in animal studies, and increases mandible salivary gland acini numbers along with lacunar osteoblast survival. By supporting new blood vessel formation and cellular survival, it helps restore the foundation necessary for tissue regeneration and recovery in patients suffering from ORN.
ORN treatment is among the fourteen clinical applications for Hyperbaric Oxygen approved by the Undersea & Hyperbaric Medical Society (UHMS). Through increased oxygen delivery, stimulation of new blood vessel growth, reduction of inflammation, and enhancement of tissue repair mechanisms, the treatment addresses many of the underlying factors that contribute to the development and progression of osteoradionecrosis.
For patients undergoing radiation therapy or those already diagnosed with ORN, HBOT may serve as a valuable adjunctive treatment, helping improve healing outcomes and supporting recovery before and after surgical intervention when indicated.
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Resources
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7501368/
- https://www.sciencedirect.com/science/article/pii/S0167814021090174
- https://www.joms.org/article/S0278–2391(10)00133–3/abstract
