Osteoradionecrosis (ORN) refers to necrotic bone that remains unhealed for a minimum of 3 months following radiotherapy in an irradiated region. The aim of this systematic meta-analysis was to evaluate the efficacy of hyperbaric oxygen therapy and surgery alone or in combination in the treatment of patients with ORN.

A systematic review and analysis of literature were performed to ascertain the role of surgery and HBO in the treatment of ORN. In May 2024 we updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 1), MEDLINE, EMBASE, DORCTIHM and reference lists of articles.

Among patients who underwent both HBO and surgery, the success rate of the treatment was 69 % (95 % Confidence Interval [CI]: 0.47-0.85, df = 9). Patients who solely received HBO had a success rate of 38 % (CI: 0.20-0.61, df = 4), while those who only had surgery had a success rate of 36 % (CI: 0.19-0.58, df = 3). The statistical analysis showed no significant difference in the results between patients who received only hyperbaric oxygen therapy or surgical treatment (z=0.139, p=0.889). The analysis indicated significant disparities in treatment success rates among patients receiving a combination of HBO and surgery compared to those treated solely with HBO or surgery alone (z = 2.428, p = 0.015 for HBO vs HBO+surgery, z = 2.655, p = 0.008 for surgery vs HBO+surgery).

The findings of this study indicate that the combination of HBO and surgery is a more effective approach for managing ORN, with better results observed when treatments are combined rather than used individually.