• Osteoradionecrosis can be characterized as impaired wound healing due to the nature of radiation induced vasculitis and subsequent radiation fibrosis which severely compromises or even eliminates the microvasculature of the periosteum as well as endosteal tissue vascular channels while challenging and disabling the overlying integumental vascular plexus as well. There is a certain amount of intranuclear destruction that does occur in all cells present in the radiated field rendering some cell death through DNA disruption; however, the majority of injury occurs to the endothelial vascular lining via superoxide radicals. The time honored protocol for the administration of HBO to an irradiated patient in preparation for mandibular reconstruction is 20 preoperative treatments followed by surgery and 10 postoperative treatments. This protocol assumes that a diagnosis of osteoradionecrosis of the mandible has not been met. When such a diagnosis is met, the patient receives 30 treatments of HBO initially followed by reevaluation.
  • HBO creates an oxygen gradient in radiated tissue. This steep oxygen gradient stimulates the normal wound healing mechanism that is missing in radiated tissue. The effects of HBO fall off when the tissue is sufficiently revascularized so that it no longer generates a sufficient oxygen gradient to continue the angiogenic process.