Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Summary
Patients were randomly assigned to one of two groups. The comparison group (n = 37)
received one million units of aqueous penicillin G intravenously prior to surgery and
500 mg phenoxymethylpenicillin four times a day for 10 days after surgery. The
intervention group was exposed to HBO in an unstated chamber at 2.4 ATA for 90
minutes. This group underwent 20 sessions before surgery, then 10 sessions after tooth
removal, once daily, for five to six days per week. The main outcome of interest was the
clinical diagnosis of osteoradionecrosis during follow-up. The diagnosis was made if
exposed bone was present six months after therapy.
Two people in the intervention group were diagnosed as having osteoradionecrosis
during follow up, compared to 11 people in the comparison group (p = 0.0060).
The study provided evidence that exposure to HBOT is more efficacious than penicillin
in the prevention of osteoradionecrosis in this population of patients. The patient sample
is representative of the potential target population to which inferences from this report
are to be applied.
Treatment
Granstrom et al60 investigated the efficacy of hyperbaric oxygen therapy on the failure
rate of osseointegration of implants following irradiation. The comparative study was
published in 1999 and enrolled 78 patients over a recruitment period of 16 years. All
patients underwent rehabilitation in a Swedish hospital following cancer surgery affecting
the head and neck. The study was non-randomised. Masking and losses to follow-up
were not described.
The patients were divided into four groups. The three groups directly relevant to this
assessment included one group of 32 patients (irradiated group, 18 males, mean age of
67.4 years) with endosseous implants who underwent irradiation prior to surgery. In this
group, the mean radiation dose was 57.7 Gray, with a mean observation time of 5.8 years.
A second group of 20 patients (HBO group, 11 males, mean age of 61.1 years) were
exposed to HBO in a monoplace chamber at about 2.5 ATA for 90 minutes following
irradiation (mean dose of 65.4 Gray). Surgery was performed after 20 sessions of
HBOT, and patients were exposed to HBO 10 more times following surgery. The effect
of HBO on reimplanted devices was examined in a smaller group of 10 patients
(reimplant group, 5 males, mean age of 61.1 years) using the same HBOT protocol
described above. Results are shown in Table 31.
Table 31
al).
Outcomes in three groups following surgery for osseointegrated implants (Granstrom et
60 *
Outcome HBO Group Irradiated Group Reimplant Group
(n=20)
(n=32)
(n=10)
Number of implants (n) 99 147 43
Percentage failed (%) 8.1 53.7 79.0
Number of patients with no implant loss (n) 14 4 0
Mortality rate (%) 15.0 21.8 10.0
* Abbreviations: n = sample size.
40 Hyperbaric oxygen therapy