ORN HBOT duration

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A patient was referred back to HBOT in June 2024 by her maxillofacial surgeon and has completed 78 treatments since that time. Recent maxillofacial surgeon note states now stage 2. Surgeon continues to recommend HBOT at follow ups. Improvement documented as improved swelling, pain, and bone exposure with 5mm exposed bone most recently in October.

Also from Oct surgeon visit: CT 8/31/24 Bilateral extracted mandibular teeth with residual osseous material within the bilateral mandibular alveolus with periapical lucencies. Lack of continuity on R mandibular body region that is consistent with microfracture (non displaced) that would be treated conservatively with soft diet, strict oral hygiene with peridex and warm water with salt, cont HBOT. 5mm bone exposure in left mandible in premolar/molar region with mild edematous surrounding soft tissue. Cont PO antibiotics, continue HBOT, postpone bone biopsy for now. Order CT scan of neck.

Insight for continuing or stopping HBOT? Thank you.

Nov 5, 2024 by Sarah Karson, RN, BSN

1 replies

Mike White
MD, UHM, MMM, CWS

Sarah,

I'm assuming this is an ORN case. The typical treatment, depending on the Marx staging, would be 30 treatments pre-surgery, and 10 treatments post surgery. For Stage 3 ORN, where the patient will be having a staged procedure, some practioners will bring the patient back after the second procedure for an additional 10 treatments. In most cases, HBO is used to "prepare" the wound bed/bone for a definitive surgical procedure. Some patients with concomitant ORN and STRN will be treated beyond the typical 40 treatments but this is for STRN. All of that to say, that 78 treatments for straight ORN is somewhat atypical. Some questions I would have would be:

Does the patient also have STRN?

How much radiation did the patient have?

What surgical procedures have been performed?

Has a Tcom been performed?

What is the goal for this patient?

I would anticipate that the supervising HBO physician and the maxilofacial surgeon have talked and come up with a treatment plan for this patient.

Just food for thought.

Mike White

Nov 7, 2024

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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