Oral and Maxillofacial Surgeons in Atlanta Follow the Marx Protocol for Head and Neck Cancer Patients (prophylactic pre- and post-treatment for patients undergoing dental surgery of a radiated jaw)

Treatment and prevention of radiation necrosis of the mandible as a result of avascular, aseptic necrosis is the most widely applied and extensively documented indication for hyperbaric oxygen in chronic radiation injury.  

Hyperbaric oxygen therapy is delivered at HyOx using the evidence-based Marx Protocol prior to oral surgeries including tooth extractions in heavily irradiated mandibles (jaws) from head and neck cancers. The hyperbaric medicine protocol continues post-surgery to help support tissue metabolic demands in the healing process. The most common post-surgical hyperbaric oxygen treatment for head and neck cancer is maxillofacial osteoradionecrosis (ORN) and osteomyelitis affecting the jawbone and surrounding tissues. The treatment also has shown to support dental implants in radiated tissues.

Hyperbaric oxygen therapy delivered at HyOx works to prevent radiation injury when the likelihood of complications from surgery is very high. It provides the oral & maxillofacial surgeon or dentist a better healing environment by stimulating growth of new capillaries and blood vessels (revascularization) around the injured tissue.

Marx Protocol for ORN and Oral Surgery/Tooth Extraction

The most widely accepted and extensively documented indication for hyperbaric oxygen therapy in chronic radiation injury is its application in the treatment and prevention of radiation necrosis of the mandible or jaw bone.  HyOx follows the Marx Protocol for hyperbaric oxygen therapy in such cases as developed by Robert E. Marx, DDS.  The Marx Protocol is the original staging system for classifying and treatment mandibular ORN and treating former head and neck cancer patients prior to extraction of teeth since the viability of soft tissue may have been compromised due to radiation therapy.

For the prevention and management of ORN using the hyperbaric medicine’s Marx Protocol (stages 1-3) results in more than 95 percent of patients successfully cured of their disease with predictable, functional and aesthetically acceptable outcomes:

Stage I ORN/Extraction

Patients with exposed bone who have no serious manifestations of those in Stage III. Begin with 30 hyperbaric oxygen treatments with no debridement or only minor bony debridement. If patient progresses, HyOx will administer 10 additional hyperbaric oxygen treatments.

Stage II ORN

If not progressing, Stage II patients should receive surgical debridement and 30 hyperbaric oxygen treatments followed by 10 post-operative treatments. Surgery for Stage II patients must maintain mandibular continuity.

Stage III ORN

If mandibular continuity is not achieved, Stage III patients are entered into a reconstructive protocol where a mandibular resection if followed by a planned reconstruction. All necrotic bone must be surgically eradicated. Stage III patients receive 30 hyperbaric oxygen treatments prior to resection followed by 10 post-resection treatments.

Head and neck cancer patients who have been previously radiated to treat cancer benefit from hyperbaric oxygen therapy by its ability to:

• Improve vascularity of the previously radiated jawbone and surrounding tissues.

• Expedite healing of ORN.

• Prepare the surgical site prior to oral surgery to help ensure more viable tissue and bone.

• Prevent mandibular necrosis as a result of tooth extraction.

• Diminish pain.

• Restore mandibular function and wearing of dental appliances, if needed.

• Maintain intact mucosa and skin over all bone to prevent a chronic wound and infection.

WHEN TO CALL HYOX:

If you’ve had radiation to the head or neck, immediately, prior to any invasive head, neck or dental procedure or you may be at risk of losing your jaw.  All insurers cover hyperbaric oxygen treatment prior to and after invasive oral surgery including tooth extraction.   

Download the Head and Neck Cancer Patient Education Condition Flyer