Hyperbaric Oxygen Therapy in the Management of Radiation-Induced Injury in the Head and Neck Region: A Review of the Literature

doi:10.1016/j.joms.2010.02.040

Journal of Oral and Maxillofacial Surgery

Volume 68, Issue 8, August 2010, Pages 1732-1739

https://doi.org/10.1016/j.joms.2010.02.040 Get rights and content

Purpose

Radiotherapy is generally used in the treatment of malignant tumors in the head and neck region. It causes a hypoxic, hypocellular, and hypovascular environment that leads to injury to surrounding normal tissue, both acute and chronic, ranging from xerostomia to osteoradionecrosis. These side effects are debilitating and greatly influence quality of life in these patients. Hyperbaric oxygen (HBO) therapy is clinically used to prevent or treat these side effects by enhancing oxygen pressure and thereby regeneration. Although this therapy is widely applied, its mechanism of action is still poorly understood, and controversy exists in the literature about its clinical use. This review therefore aims to analyze the existing experimental and clinical research on this topic.

Materials and Methods

A systematic search was performed in PubMed for experimental and clinical studies conducted regarding the use of HBO therapy in previously irradiated tissue, in the period from January 1990 to June 2009.

Results

Experimental research is scarce, and clinical studies are especially lacking in terms of randomized controlled studies. Although discussions on the subject are ongoing, most studies suggest a beneficial role for HBO in previously irradiated tissue.

Conclusion

Further research, both experimental and clinical, is necessary to unravel the working mechanism of HBO therapy and validate its clinical use.

Section snippets

Osteoradionecrosis

An early side effect of radiotherapy in the head and neck region is xerostomia. The mucus that is secreted by salivary glands thickens because of a change in composition. Patients with xerostomia have a dry mouth, which results in difficulties with eating and speech. Repair of salivary gland tissue is problematic, and provided that it occurs, will take months to years.² Xerostomia causes an environment that is more prone to develop dental caries, which in turn can lead to periapical infection

Hyperbaric Oxygen Therapy

The delivery of oxygen is an essential process when considering (bone) tissue repair. Inadequate vascularity of bone reduces osteogenesis and thus bone mass. Most osteogenic factors stimulate angiogenesis, and when angiogenesis is inhibited during the repair of bone fractures, fibrous tissue is formed instead of bone.⁸ Oxygen stimulates collagen synthesis, matrix deposition, angiogenesis, epithelialization, and the eradication of bacteria.⁹ The use of hyperbaric oxygen (HBO) therapy in

Materials and Methods

A systematic search of the literature was performed by use of the PubMed database with the following key words, as well as combinations of these terms: hyperbaric oxygen, irradiation, radiation, radiotherapy, maxillofacial, craniofacial, head and neck, bone, mandible, soft tissue, salivary glands, and mucosa. Only articles written in English within the time period from January 1990 to June 2009 were included. Experimental and clinical studies were included, whereas case reports were excluded.

Working Mechanism of HBO

Experimental studies regarding the working mechanism of HBO in general were evaluated to give a brief overview of the existing knowledge. In vitro9, 13, 14, 15 and in vivo16, 17, 18, 19, 20 studies were included, and the results of these studies will be reviewed in the “Discussion” section.

Experimental Research

The next step was to identify experimental studies that consider the effect of HBO on irradiated bone tissue. Five studies were found that focused on the cancellous bone of the hind legs of rabbits or mice,

Discussion

HBO has been used since the late 1950s to treat a variety of conditions, such as syphilis, multiple sclerosis, myocardial infarction, gangrene, and decompression sickness.⁵⁴ ORN—a late irradiation complication—could, in theory, benefit from HBO use, either prophylactically or therapeutically. However, conflicting opinions about the efficacy exist, hence this review on experimental and clinical studies reported in the literature.

Marx, the founder of the so-called 3H model (hypoxia,

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Basic and patient-oriented researchHyperbaric Oxygen Therapy in the Management of Radiation-Induced Injury in the Head and Neck Region: A Review of the Literature

Purpose

Materials and Methods

Results

Conclusion

Section snippets

Osteoradionecrosis

Hyperbaric Oxygen Therapy

Materials and Methods

Working Mechanism of HBO

Experimental Research

Discussion

Int J Radiat Oncol Biol Phys

Lancet Oncol

Int J Radiat Oncol Biol Phys

Int J Oral Maxillofac Surg

Am J Otolaryngol

Oral Surg Oral Med Oral Pathol

Drug Discov Today

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Am J Orthod Dentofacial Orthop

Connect Tissue Res

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Exp Mol Pathol

Int J Oral Maxillofac Implants

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Arch Oral Biol

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Br J Plast Surg

J Prosthet Dent

Int J Radiat Oncol Biol Phys

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Eur J Cancer B Oral Oncol

Oral Oncol

Basic and patient-oriented research
Hyperbaric Oxygen Therapy in the Management of Radiation-Induced Injury in the Head and Neck Region: A Review of the Literature