Effectiveness of Hyperbaric Oxygen Therapy Compared to Surgical Free Tissue Flap for Osteoradionecrosis of the Jaw: A Meta-Analysis
Bibliographic record
Abstract
ABSTRACT Background Osteoradionecrosis (ORN) of the jaw is an uncommon but potentially serious complication of radiation therapy for head and neck cancer, with many cases presenting months to years after completion of radiotherapy. ORN-related morbidity is high, making effective management of osteoradionecrosis essential. Current treatment options include hyperbaric oxygen therapy (HBOT), surgical management (free flap), and PENTOCLO, among others. Our goal is to analyze the reported efficacy of hyperbaric oxygen therapy versus microvascular free flap in ORN. Methods This review was conducted using the Preferred Reporting Items for Systematic Review & Meta-Analysis (PRISMA) guidelines. A systematic review search strategy was developed by a librarian (JED). The search was performed in the following databases on March 8, 2023: PubMed, EMBASE, and ClinicalTrials.gov . Two reviewers independently assessed the titles, abstracts, and full-text manuscripts based on predetermined inclusion and exclusion criteria. The risk of bias of the final included studies was assessed using the Newcastle-Ottawa Scale. final included studies were assessed using the Newcastle-Ottawa risk of bias assessment, and analyses were performed using risk ratios. Results The initial search yielded 1,614 articles with 407 undergoing full-text review. Ultimately, nine studies met the eligibility criteria and were included in the review. In total, 339 patients were included across the nine studies. Each of the nine studies reported on resolution of ORN with HBOT versus surgical free flap, with six studies showing significant differences in outcomes, with surgical free flap yielding significantly higher complete resolution of ORN compared to HBOT (RR 0.42, 95% CI 0.2-0.85; RR 0.07, 95% CI 0-0.99; RR 0.04, 95% CI 0-0.57; RR 0.12, 95% CI 0.04-0.34; RR 0.21, 95% CI 0.08-0.54; RR 0.43, 95% CI 0.24-0.78). Three studies showed no significant differences in ORN resolution (RR 0.33, 95% CI 0.03-4.19; RR 0.33, 95% CI 0.03-4.19; RR 0.34, 95% CI 0.11-1.09). The summary outcome of ORN resolution found a significant difference between surgical free flap and HBOT (RR 0.28, 95% CI 0.17-0.45). Conclusions Despite the traditional practice of recommending HBOT for ORN treatment, our meta-analysis suggests that HBOT provides little benefit, especially for later stages of disease, and that surgical intervention via surgical free flap yields superior outcomes. However, there may be some benefit of HBOT in conservative management of early and intermediate cases of ORN. Surgical reconstruction with microvascular free flap may be a superior alternative to HBOT in the management of these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.032 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.060 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".