Marx3
The addition of hyperbaric oxygen therapy bracketed around hemi-mandibular reconstruction in an irradiated field improved the success rate of surgery.
Clinical Bottom Line: 1. The addition of hyperbaric oxygen to the surgical management of jaw reconstruction improved the success rate of the operation as defined by continuity, alveolar bone height, osseous bulk, facial form and elimination of soft tissue deficiency. 2. There was a trend to lower complication rates that did not reach statistical significance.
Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital Sydney; Tuesday, 13 April 1999
Clinical Scenario: A patient presented for a hemi-mandibular jaw reconstruction following radiotherapy and surgery. We wondered if the addition of hyperbaric oxygen would improve outcome. Three-part Question: In patients requiring reconstructive surgery to the mandible in a field with previous surgery and radiotherapy for carcinoma of the oropharynx, does the addition of hyperbaric oxygen before and after reconstruction result in any improvement in outcome or complication rate. Search Terms: Oropharynx carcinoma, reconstructive surgery.
The Study: Non-blinded randomised controlled trial without intention-to-treat. Little detail given. Patients requiring hemi-mandibular jaw reconstruction in a tissue bed previously irradiated with at least 6,400 cGy. Control group (N = 52; 52 analysed): Standard surgical technique Experimental group (N = 52; 52 analysed): As above but 20 hyperbaric treatments before and 10 after surgery (dose not stated in report).
The Evidence:
Outcome |
Time to Outcome |
Control group |
HBO group |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Success |
unknown |
0.65 |
0.92 |
41% |
0.27 |
4 |
95% CI: |
18% to 64% |
0.12 to 0.42 |
2 to 8 | |||
|
Complication |
unknown |
0.21 |
0.10 |
55% |
0.12 |
9 |
95% CI: |
-10% to 100% |
-0.02 to 0.25 |
NNT 4 to INF NNH 48 to INF | |||
Comments: 1. Very brief report in a textbook. No details of methods employed. 2. Other work from this author strongly suggests a regime of oxygen at 2.4ATA daily five times each week for 20 treatments pre-op and ten post-operatively.
Expiry date: December 2019
References: 1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999; 683-687.
