Effectiveness of Hyperbaric Oxygen Therapy Compared to Surgical Free Tissue Flap for Osteoradionecrosis of the Jaw: A Meta-Analysis

BackgroundOsteoradionecrosis (ORN) of the jaw is an uncommon but potentially serious complication of radiation therapy for head and neck cancer, with many cases presenting months to years after completion of radiotherapy. ORN-related morbidity is high, making effective management of osteoradionecrosis essential. Current treatment options include hyperbaric oxygen therapy (HBOT), surgical management (free flap), and PENTOCLO, among others. Our goal is to analyze the reported efficacy of hyperbaric oxygen therapy versus microvascular free flap in ORN. MethodsThis review was conducted using the Preferred Reporting Items for Systematic Review & Meta-Analysis (PRISMA) guidelines. A systematic review search strategy was developed by a librarian (JED). The search was performed in the following databases on March 8, 2023: PubMed, EMBASE, and ClinicalTrials.gov. Two reviewers independently assessed the titles, abstracts, and full-text manuscripts based on predetermined inclusion and exclusion criteria. The risk of bias of the final included studies was assessed using the Newcastle-Ottawa Scale. final included studies were assessed using the Newcastle-Ottawa risk of bias assessment, and analyses were performed using risk ratios. ResultsThe initial search yielded 1,614 articles with 407 undergoing full-text review. Ultimately, nine studies met the eligibility criteria and were included in the review. In total, 339 patients were included across the nine studies. Each of the nine studies reported on resolution of ORN with HBOT versus surgical free flap, with six studies showing significant differences in outcomes, with surgical free flap yielding significantly higher complete resolution of ORN compared to HBOT (RR 0.42, 95% CI 0.2-0.85; RR 0.07, 95% CI 0-0.99; RR 0.04, 95% CI 0-0.57; RR 0.12, 95% CI 0.04-0.34; RR 0.21, 95% CI 0.08-0.54; RR 0.43, 95% CI 0.24-0.78). Three studies showed no significant differences in ORN resolution (RR 0.33, 95% CI 0.03-4.19; RR 0.33, 95% CI 0.03-4.19; RR 0.34, 95% CI 0.11-1.09). The summary outcome of ORN resolution found a significant difference between surgical free flap and HBOT (RR 0.28, 95% CI 0.17-0.45). ConclusionsDespite the traditional practice of recommending HBOT for ORN treatment, our meta-analysis suggests that HBOT provides little benefit, especially for later stages of disease, and that surgical intervention via surgical free flap yields superior outcomes. However, there may be some benefit of HBOT in conservative management of early and intermediate cases of ORN. Surgical reconstruction with microvascular free flap may be a superior alternative to HBOT in the management of these patients.