Hyperbaric oxygen therapy for wounds of the face, head and neck

Wounds within the face, head, and neck region can have devastating aesthetic, functional, and potentially fatal outcomes for patients and often require multimodality treatment. Here we discuss the role of hyperbaric oxygen for a variety of wounds within the head and neck region and the clinically associated outcomes.

Hyperbaric oxygen (HBO) treatment can be useful in the management of wounds and infections within the head and neck region. While there are few randomized controlled clinical trials evaluating the effectiveness of HBO therapy, there is a large amount of retrospective literature supporting its adjunctive role in the treatment of radiation associated head and neck wounds, compromised grafts and flaps, and necrotizing soft tissue infections. The most common treatment protocols are typically initiated at 2-2.4 atmosphere absolute (ATA) at 100% oxygen for 90 min for 30 daily sessions, though this varies significantly in the available literature. In the setting of osteoradionecrosis (ORN) and medication-induced osteonecrosis of the jaw (MRONJ), however, emerging treatments such as the Potentiation by Clodronate (PENTOCLO) protocol may provide more effective treatment that HBO therapy.

Hyperbaric oxygen therapy should be considered as an adjuvant therapy for head and neck wounds involving radiated soft tissue, compromised local and free flaps, filler-induced soft tissue necrosis or blindness, and for necrotizing soft tissue infection; however, more randomized controlled trials are needed to better evaluate both their clinical impact as well as better establish treatment protocols, particularly in the setting of ORN and MRONJ.