Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: treatment.

Osteoradionecrosis (ORN) is a serious condition following treatment for head and neck cancer with serious associated morbidity and mortality. While the use of hyperbaric oxygen (HBO) in treating established osteoradionecrosis has been standard practice in many units for years, the evidence base for this remains remarkably weak. The published evidence has been made even more controversial by trial protocols that do not use HBO as it is generally advocated. This review describes the classification, incidence, and treatment of ORN, and explores the available published evidence with particular emphasis on randomised trials of treatment with HBO.