Osteoradionecrosis of the Jaw

Osteoradionecrosis of the Jaw(s)
Mandibular Osteoradionecrosis
Mandibular Radiation Necrosis
Osteoradionecrosis (ORN)


Radiation therapy can cause acute, sub acute, and delayed injuries. Acute and sub acute injuries occur during or soon after completion of radiation therapy and are generally self-limited. However, delayed injuries are often persistent, are much more difficult to treat and may appear anywhere from 3 months to years after completion of radiation therapy treatment. These injuries can cause significant debilitation to patients. Often, delayed injuries are precipitated by an additional tissue insult such as a procedure or surgery within the radiation field. While the exact causes and biochemical processes leading to delayed radiation injury are complex and are not yet fully understood, the generally accepted explanation is that these complications result from damage, scarring and narrowing of the blood vessels within the tissues.

Hyperbaric oxygen has been proven to induce new blood vessel growth within these damaged tissues and lead to improvement in the oxygen availability for wound healing.

The most widely applied and most extensively documented indication for hyperbaric oxygen in chronic radiation injury is in its use in the treatment and prevention of radiation necrosis of the jaw(s). After a patient has received radiation therapy, the tissues exposed can often develop a smaller amount of blood vessels and have therefore less oxygen available to assist in healing. Problematic wounds can develop when an intervention (e.g. dental extraction, surgery, biopsy, etc.) occurs within the radiated tissue area. Patients are more at risk of developing problems years after the initial exposure to radiation treatment.

Tooth extraction is the most common cause of initiating osteoradionecrosis of the jaw(s) in a previously radiated jaw bone.

Hyperbaric oxygen therapy offers significant beneficial effects in the treatment of osteoradionecrosis. Additionally, hyperbaric oxygen is also used in the prevention of developing osteoradionecrosis when dental extractions and surgical procedures are planned for in the area where radiation treatment was delivered. For these conditions, as well as other radiation damaged bone and soft tissues, hyperbaric oxygen is the only treatment that has been shown in clinical trials to reverse the damaging affects of radiation. It has been used successfully in the treatment of delayed radiation injury for over 30 for years. Hyperbaric oxygen treatment allows more oxygen to reach these radiation damaged areas. A series of hyperbaric oxygen treatments can help to stimulate new blood vessels to grow. This gives the body the opportunity to heal and significantly improve, if not totally relieve patients of their presenting symptoms.  Hyperbaric oxygen also increases the ability of infection-fighting white blood cells to kill harmful bacteria and accelerate healing. If surgery is necessary in the area of previous radiation, post operative healing may be impaired. Oxygen delivered at hyperbaric pressures helps prepare tissues for healing by producing new blood vessels in irradiated areas.

Additional indications for hyperbaric oxygen therapy may be discussed with your doctor and the Hyperbaric Medicine Team. Hyperbaric oxygen therapy is usually used as an adjunct to additional care the patient is receiving. Additional treatments may also include antibiotic therapy, nutritional support, and surgical procedures, if indicated.  Our Hyperbaric Medicine Team will work closely with your physician(s) to coordinate any additional care needed.

Contact the Hyperbaric Medicine Department at MemorialCare, Long Beach Medical Center for more information.

MemorialCare, Long Beach Medical Center
Department of Hyperbaric Medicine
2801 Atlantic Avenue
Long Beach, California 90806

Telephone: (562) 933-6960

 Fax: (562) 933-6060