Use of hyperbaric oxygen in postradiation head and neck surgery.

Data are presented to indicate the value of hyperbaric oxygen in all stages of treatment of patients with irradiation complications following head and neck surgery. Hyperbaric oxygen stimulates angiogenesis, with increased neovascularization and optimization of cellular levels of oxygen for osteoblast and fibroblast proliferation, collagen formation, and support of ingrowing blood vessels. The hypoxic, acellular matrix in the postirradiated field is changed to a hypercellular, hyperoxic/normoxic situation. Oxygen is used as an adjunct to appropriate surgery. By using the two modalities together, the salvage rate for osteoradionecrosis and its complications of orocutaneous fistula, pathological fractures, and severe bone losses can be increased dramatically. It may also be used prophylactically in patients with periodontal disease or teeth requiring extraction in a previously irradiated area. Finally, the use of oxygen helps support tissue flaps and grafts placed into previously irradiated areas. Economically, there is considerable cost savings in the use of hyperbaric oxygen therapy with appropriate surgery. From the patient's point of view, pain relief is achieved, function is returned, and prognosis improves in a relatively short time.