Hyperbaric Oxygen Therapy | New Hope For Osteoradionecrosis Patients

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At CūtisCare we’re celebrating Health for the Holidays this December.

We couldn’t think of a better way to share some holiday cheer than by sharing hope and solidarity with our valued clients and patients everywhere who have utilized, and benefited from, wound care and hyperbaric oxygen therapy (HBOT). 

We also wanted to share our sincere gratitude to our clients who we have partnered with over the years in the implementation of Wound Care and Hyperbaric solutions. We thank our clients for their patronage and loyalty. Most importantly though, we thank them for the thousands of patients’ lives they have changed for the better with HBOT. We are truly humbled and grateful to have been able to contribute to their success.     

We wanted to focus this post on the benefits of HBOT for patients suffering from osteoradionecrosis, or ORN. 

The CūtisCare clinical and management teams have more than 25 years of experience in designing and implementing HBOT solutions. Our only goal is to help you to deliver outstanding patient outcomes while reducing overall treatment costs. Feel free to reach out to our team at any time to discuss any questions you may have surrounding wound care and HBOT technology and solutions.

In this post we’re going to discuss:

  • Which Patients Can Best Benefit From HBOT For Osteoradionecrosis?
  • What Does An HBOT Treatment Plan for ORN Look Like And What Are The Specific Benefits? 
  • How Can You Get Started On The Path To Better ORN Patient Outcomes?  

UCLA Health is the number one ranked health system in California, and #3 in the nation. Let’s get their take on HBOT for osteoradionecrosis:

For most cancer patients who experience negative effects from radiotherapy, the side effects are short-term and appear within six months of their last exposure to radiation...This can lead to inadequate blood supply and result in chronic, long-term side effects including death or damage to soft tissues or bones (necrosis, radionecrosis or osteoradionecrosis), poor wound healing and related problems such as life-threatening infections. As many as 10 to 15 percent of patients receiving high doses of radiotherapy will experience these late side effects from radiotherapy, which may be delayed for several months or years after treatment has ended.

HBOT has emerged as an effective treatment for some patients who previously had little hope of recovering from late side effects of radiotherapy (like osteoradionecrosis).

Osteoradionecrosis (ORN) is caused when radiation therapy damages the blood vessels that supply the jawbone with nutrients and oxygen. Without an adequate blood supply, the bone can no longer heal itself when faced with infection or trauma, and it dies. Hyperbaric Oxygen Therapy, as a critical component of a comprehensive treatment plan, has been shown to reduce, or even reverse, some of the late effects of radiation therapy. 

Statistics show that ORN will be developed in approximately 15% of head and neck cancer patients who have been treated with radiation therapy. The disease can be particularly devastating because the patient is often unaware of it until there is a local aggravation that exposes it. ORN is frequently discovered when the condition is aggravated by a dental procedure, especially a tooth extraction.   

ORN refers to a severe delayed radiation-induced injury and is characterized by bone tissue necrosis and failure in healing due to damaged blood vessels surrounding the injured bone tissue.

Which Patients Can Best Benefit From HBOT For Osteoradionecrosis?

Many of the pioneering studies on hyperbaric oxygen for osteoradionecrosis were done by Dr. Robert Marx, DDS. Dr. Marx developed a staging system and treatment protocols for osteoradionecrosis based on the severity of the disease.

ORN expert Dr. Munier M.S. Nazzal, MD, of the University of Toledo, Medical Center, gave some clarification recently at leading online HBOT information resource Hyperbaric Aware:  

Stage I: Patients with exposed bone which has been chronically present or which developed rapidly. Patients are treated with 30 hyperbaric treatments preoperatively followed by bony debridement. Postoperatively they are given an additional ten treatments.

Stage II: These are patients who do not respond favorably to 30 pre-operative treatments, or when a more major operative debridement is required. Surgery for stage II osteoradionecrosis patients must be focused on preserving the integrity of the mandible. If mandibular resection is anticipated, patients are advanced to Stage III.

Stage III: Along with patients who have progressed from stages I and II, patients with stage III osteoradionecrosis have serious and potentially grave prognostic findings such as pathologic fracture, percutaneous fistulae, and lytic lesions that extend to the inferior border of the mandible. For patients with stage III osteoradionecrosis, mandibular resection is planned as part of the surgical treatment. It is critical that all necrotic bone be debrided and removed in stage III patients. Stage III osteoradionecrosis patients receive 30 treatments preoperatively followed by ten hyperbaric oxygen treatments postoperatively (Davis, et al.).

Hopefully, that provides some high-level clarification on the stages and treatment of ORN in head and neck cancer patients. If you’re interested in some more detail, check out the entire post by Dr. Nazzal at Hyperbaric Aware

What Does An HBOT Treatment Plan for ORN Look Like And What Are The Specific Benefits?

As pointed out by Dr. Nazzal, HBOT is one part of a comprehensive treatment program inclusive of the patient’s maxillofacial surgeon when applicable. The treatment plan may include surgery, surgical debridement, hyperbaric oxygen therapy, wound care, soft tissue grafts, and antibacterial medications, depending on the severity of the disease.

The benefits of HBOT can be life-changing. By exposing the patient to pure oxygen at elevated pressures above atmospheric, HBOT stimulates necrotic bone and soft tissue healing from the inside of the wound, outward. Some of the healing effects include: 

  • Increased dissolved oxygen increases the amount of oxygenated plasma that is dissolved in tissue
  • Increased growth factor synthesis, stem cell proliferation, diminished inflammatory response and enhanced white blood cell killing of bacteria
  • Stimulates angiogenesis and neovascularization through multiple encounters of increased and normobaric oxygen tensions
  • Direct pressure of HBO helps reduce edema caused by infection and surgery
  • Normalizing oxygen tensions in tissue fluids promotes active transport of antibiotics into microorganisms 
  • Resorption of infected bone is observed only after HBO treatments are started

HBOT is also approved by Medicare to treat patients with a variety of medical conditions, in addition to osteoradionecrosis.

Would You Like To Know How You Can You Get Started On The Path To Better ORN Patient Outcomes?  

That’s the easy part. If you think your hospital, practice, or clinic could benefit from improved wound care capabilities, get in touch with our team. We’re here to help answer any questions you might have 

Also, see what patients are saying about the life-changing value of these treatments

At CūtisCare our HBOT solutions are designed to fill a critical void that exists in the wound care treatment and healing space. We are a healing-centric, compliance-driven organization. Our goal is to provide innovative, effective, purpose-built clinical solutions for wound care management and treatment.  

Our team is laser-focused and passionate about facilitating exceptional patient outcomes through flexible, economical, and innovative HBOT solutions. In a nutshell, we provide hospitals, research facilities, clinics, and private practices nationwide with the solutions and expertise to treat their patients’ chronic wound problems. 

Our wound care management and hyperbaric oxygen therapy for osteoradionecrosis are proven treatments designed to:  

  • Accelerate the wound healing process
  • Increase oxygenation to all tissues
  • Promote collagen and new skin development
  • Reduce swelling and discomfort
  • Promote new blood vessel formation
  • Increase capillary growth
  • Activate bactericidal, bacteria-killing activity 

Are you looking for more efficient treatment options for your patients who received radiation after a cancer diagnosis? Would you like to become a recognized wound care center of excellence? Or do you just have some questions about wound care and Hyperbaric Medicine? 

Regardless of where you are in the process, we’d love to share our 25 years of knowledge and experience with you. Get in touch with one of our HBOT thought leaders today.