RevitalizeMe
Hyperbaric Oxygen & Wound Care
3200 Cabaret Trail S., Suite 3 | Saginaw, MI 48603
(989) 320-4434 | HyperbaricWoundCare.com
(989) 320-4434 | HyperbaricWoundCare.com
Clinical Evidence Summary
Osteoradionecrosis of the Jaw & HBOT
FDA & CMS Approved — Marx Protocol
| Medicare & Medicaid Covered
29%
Reduction in ORN recurrence with Marx Protocol vs. surgery alone
Marx RE, J Oral Maxillofac Surg 1983
20+10
Pre-op + post-op dives — standard Marx Protocol for ORN surgery
CMS Coverage Policy NCD 20.29
30
HBOT sessions for conservative (non-surgical) ORN management
CMS Coverage Policy NCD 20.29
5–15%
Of head and neck radiation patients develop ORN
Clinical Epidemiology
Clinical Overview
Osteoradionecrosis (ORN) of the jaw is one of the most devastating complications of head and neck radiotherapy — resulting in exposed, necrotic bone that fails to heal due to radiation-induced obliterative endarteritis. The Marx Protocol, developed by Dr. Robert Marx, established HBOT as the standard of care for ORN prevention and treatment. By driving neoangiogenesis in hypoxic, hypovascular mandibular tissue, HBOT creates the biological conditions necessary for bone healing and surgical success.
Key Published Evidence
J. Oral & Maxillofacial Surgery — Marx Protocol Study
Marx established that radiation renders mandibular bone hypoxic and hypovascular, and that HBOT (20 pre-op + 10 post-op sessions) resulted in significantly superior healing outcomes compared to surgery alone, with dramatically lower recurrence rates in ORN patients.
Marx RE. J Oral Maxillofac Surg. 1983;41(5):283–286.
Oral Surgery, Oral Medicine — Landmark Radiobiology Study
Marx and Johnson demonstrated that the irradiated mandible exists in a state of permanent hypoxic-hypovascular-hypocellular tissue, and that HBOT incrementally restores vascularity and oxygenation with each session — providing the mechanistic basis for the Marx Protocol.
Marx RE, Johnson RP. Oral Surg Oral Med Oral Pathol. 1987;64(4):379–390.
Medicare Coverage — Dental Extractions in Irradiated Jaw
CMS also covers HBOT prior to and following dental extractions in previously irradiated mandible or maxilla (typically 20 pre-op + 10 post-op sessions) to prevent ORN development. This is a critical preventive indication for OMS and dental oncology patients.
CMS National Coverage Determination 20.29
How HBOT Works
1
Drives neoangiogenesis in radiation-damaged, avascular mandibular bone
2
Restores fibroblast proliferation and collagen synthesis capacity
3
Pre-op HBOT creates a vascularized wound bed before surgical resection
4
Post-op HBOT sustains healing and reduces flap failure and recurrence
Ideal Referral Candidate
Diagnosed or suspected ORN following head and neck radiation
Planned mandibular resection or sequestrectomy in irradiated field
Dental extractions planned in previously irradiated jaw
Free flap jaw reconstruction in irradiated tissue bed
Non-healing oral surgical wound in radiation field
Standard HBOT Protocol
ORN Surgery
20 pre + 10 post
Conservative Mgmt
30 sessions
Dental Extractions
20 pre + 10 post
Pressure
2.4 ATA / 90 min