Hyperbaric Oxygen Effects on Surgical Outcomes in Mandibular Osteoradionecrosis Requiring Segmental Resection and Free Tissue Transfer

<b>Background:</b> Treatment of head and neck cancer with radiation can cause osteoradionecrosis of the mandible (MORN), requiring removal of nonviable bone and free flap reconstruction. <b>Objective:</b> To compare surgical outcomes in patients with MORN treated with free tissue transfer who received hyperbaric oxygen therapy (HBO) to those who did not, measured by flap failure, nonunion, plate exposure, and postoperative infections. <b>Methods:</b> This retrospective cohort study evaluated 311 patients with advanced MORN treated at a single tertiary care academic center with segmental mandibulectomy and free flap reconstruction. One group received HBO preoperatively and postoperatively; the other group did not. Postoperative complications were compared using chi-square test or Fisher's exact test. <b>Results:</b> This study included 311 patients, 131 HBO group (74% male, 26% female, mean age 75.6 years), 180 in the non-HBO group (73% male, 27% female, mean age 76.3 years). Postoperative metrics included; complete flap failure (HBO = 4, non-HBO = 2), partial flap failure (HBO = 2, non-HBO = 3), nonunion (HBO = 10, non-HBO = 14) exposed plate (HBO-7, non-HBO = 8), wound infections treated surgically (HBO = 2, non-HBO = 7), wound infections treated with antibiotics alone (HBO = 5, non-HBO = 12). No differences were identified between groups. <b>Conclusion:</b> We found no difference in rates of postoperative complications between the HBO group and the non-HBO group.