Hyperbaric Oxygen Therapy: Advancing Wound Healing in Irradiated Oral Cancer Patients

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Thanapon Suwanapong
Woraluk Suwanapong

Abstract

            Hyperbaric oxygen therapy (HBO2T) is an adjunctive treatment for enhancing wound healing in patients with oral cancer who have undergone radiation therapy. Radiation-induced tissue injury (RTI) leads to compromised healing due to hypocellularity, hypovascularity, and hypoxia, predisposing patients to complications such as osteoradionecrosis (ORN). HBO2T improves tissue oxygenation by increasing plasma-dissolved oxygen under high atmospheric pressure, promoting angiogenesis, collagen synthesis, and immune function, while reducing inflammation. This article reviews the pathophysiology of RTI and ORN, the mechanisms of HBO2T in mitigating radiation injury, and clinical applications, emphasizing its therapeutic role and potential complications.

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Academic Article

References

Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F. Cancer statistics for the year 2020: an overview. Int J Cancer 2021. doi: 10.1002/ijc.33588. Online ahead of print. PMID: 33818764.

American Cancer Society. Key statistics for oral cavity and oropharyngeal cancers. [Internet]. [cited 2025 March 29]. Available from: https://www.cancer.org/cancer/types/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.

Kang TS, Gorti GK, Quan SY, Ho M, Koch RJ. Effect of hyperbaric oxygen on the growth factor profile of fibroblasts. Arch Facial Plast Surg 2004;6(1):31-5.

Ettinger KS, Ganry L, Fernandes RP. Oral Cavity Cancer. Oral Maxillofac Surg Clin North Am 2019;31(1):13-29.

Marx RE, Johnson RP. Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg Oral Med Oral Pathol 1987;64(4):379-90.

Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, editors. Abeloff's clinical oncology. 6th ed. Philadelphia: Elsevier; 2020.

Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 1983;41(5):283-8.

Delanian S, Lefaix JL. Current management for late normal tissue injury: radiation-induced fibrosis and necrosis. Semin Radiat Oncol 2007;17(2):99-107.

Manzon L, Rossi E, Fratto G. Management of osteonecrosis of the jaws induced by radiotherapy in oncological patients: preliminary results. Eur Rev Med Pharmacol Sci 2015;19(2):194-200.

Notani K, Yamazaki Y, Kitada H, Sakakibara N, Fukuda H, Omori K, et al. Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy. Head Neck 2003;25(3):181-6.

Peterson DE, Koyfman SA, Yarom N, Lynggaard CD, Ismaila N, Forner LE, et al. Prevention and management of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy: ISOO-MASCC-ASCO guideline. J Clin Oncol 2024;42(16):1975-96.

El-Rabbany M, Duchnay M, Raziee HR, Zych M, Tenenbaum H, Shah PS, et al. Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database Syst Rev 2019;2019(11):CD011559.

Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg 2011;127 (Suppl 1):131S-141S.

Tibbles PM, Edelsberg JS. Hyperbaric-oxygen therapy. N Engl J Med 1996;334(25):1642-8.

Francis A, Baynosa RC. Hyperbaric oxygen therapy for the compromised graft or flap. Adv Wound Care (New Rochelle) 2017;6(1):23-32.

Zhang Y, Zhou Y, Jia Y, Wang T, Meng D. Adverse effects of hyperbaric oxygen therapy: a systematic review and meta-analysis. Front Med (Lausanne) 2023;10:1160774.

Sadri RA, Cooper JS. Hyperbaric complications. In: StatPearls. [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 29083713.