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 |
0.654 |
0.923 |
-41% |
-0.27 |
-4 |
|
95%
CI: |
|
|
|
-64%
to -18% |
-0.42
to -0.12 |
-8
to -2 |
|
Complication |
unknown |
0.212 |
0.096 |
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: April 2003
References:
1. Marx RE. Clinical applications of hyperbaric oxygen. In:
Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999;
683-687.
