Treatment of radiation-induced tissue injury by hyperbaric oxygen.

Hyperbaric oxygen therapy appears to be a beneficial adjunctive treatment modality in the management of radionecrosis of bone and soft tissue in the head and neck. The mechanism of such wound healing enhancement appears to be related to oxygen stimulation of fibroblastic activity and neovasculation. In this pilot study, involving 13 cases of refractory mandibular radionecrosis treated with hyperbaric oxygen, complete healing of soft tissue disease with covering of exposed bone has been noted in seven cases 11 to 27 months posttreatment; transient healing was seen in three cases; moderate to marked improvement in soft tissue disease has been noted in three cases. Pain relief was marked in six cases, moderate in four cases, and slight in one case of the 11 patients with significant pretreatment pain. Radiographic improvement was slight to moderate in ten cases. Four of the five patients with pathologic fractures developed a firm fibrous union of the mandibular segments during or shortly after treatment. Three additional cases of head and neck radionecrosis of other sites have noted significant improvement in their lesions during treatment. Three other patients with radionecrosis of the foot, hip, and vagina have also been treated with good results only in the vaginal case. None of the 19 patients treated with hyperbaric oxygen developed persistent or significant complications.