{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:03Z","timestamp":1772168883592,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.155112.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000}}],"reference-count":38,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>Introduction Although relatively uncommon, osteoradionecrosis (ORN) remains a serious complication following radiotherapy. Various therapeutic approaches, including hyperbaric oxygen therapy (HBOT), are utilized in managing ORN. This study aims to evaluate the role of HBOT in ORN management and to identify predictive factors influencing the evolution of head and neck ORN after HBOT. Methods This retrospective study includes 46 patients who received HBOT for head and neck ORN between 2017 and 2020. The patients were divided into two groups: Group 1 (n=36) included those with regression or stabilization of ORN, while Group 2 (n=10) comprised patients with worsening lesions. We performed a statistical study in order to identify factors influencing ORN progression under treatment. Results ORN affected the mandible in 93.5% of patients, the maxilla in 2 cases, and the skull base in 4 cases. All patients received HBOT, with an average of 44.65 sessions. Pre-operative HBOT was administered in 17% of cases, and post-operative HBOT was given in 42% of cases. After at least 20 sessions, ORN regressed in 33% of cases, stabilized in 45%, and worsened in 22%. Analysis of factors influencing ORN progression on the univariate study revealed significant associations with high blood pressure (p=0.046), larger tumor size (p=0.004), advanced tumor stages (p=0.048), mean radiation dose (p=0.002), delays between dental care and radiotherapy (p=0.045), and the location of ORN within the mandible (p=0.049). Additionally, the number of HBOT sessions significantly affected ORN evolution, with more sessions correlating with better outcomes (p=0.001). In the multivariate analysis, variables such as the average interval between dental care and radiotherapy (p=0.043) as well as the number of HBOT sessions (p=0.040) emerged as significant influencers of ORN evolution. Conclusion Our study provides valuable insights into the management of ORN by identifying key predictors that influence the post-therapeutic evolution of head and neck ORN after HBOT.<\/ns4:p>","DOI":"10.12688\/f1000research.155112.2","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T10:50:10Z","timestamp":1735815010000},"page":"1225","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing osteoradionecrosis progression during hyperbaric oxygen therapy: A case study"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6889-4181","authenticated-orcid":false,"given":"Sameh","family":"Mezri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2279-3038","authenticated-orcid":false,"given":"Chaima","family":"Zitouni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khadija","family":"Bahrini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mounir","family":"Haggui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiem","family":"Boughzala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hedi","family":"Gharsallah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2289-2299","DOI":"10.1016\/S0140-6736(21)01550-6","article-title":"Head and neck cancer.","volume":"398","author":"M Mody","year":"2021 Dec","journal-title":"Lancet."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1084-1091","DOI":"10.1016\/j.ijrobp.2008.12.052","article-title":"Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients.","volume":"75","author":"I Lee","year":"2009","journal-title":"Int. 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These are typical symptoms of ORN and were observed in the majority of patients. Additionally, the presence of cutaneous fistulas was noted in 39% of cases, which is a key indicator of more advanced ORN. \n<u>Radiological Diagnosis:<\/u> Radiological examinations, including panoramic radiographs, CT scans, and MRI, were used to assess the severity of ORN. CT scans were the primary imaging modality for evaluating ORN progression. In our study, ORN lesions were classified according to the LENT\/SOMA grading system  \n<b>The criteria for tooth extraction indications should be clarified, with sources cited.<\/b>  We have clarified the criteria for tooth extraction indications in the discussion section.  \n<b>Details on the pre-treatment dental care performed to minimize the risk of ORN should be provided. Specifically, it should be explained what procedures were carried out as part of dental care, including professional cleaning, fluoride treatments, necessary extractions, restorations, and any patient education to promote oral hygiene during and after radiation therapy.<\/b>  We provided the necessary details about the pre-treatment dental care performed to minimize the risk of ORN.  \n<b>The criteria used for diagnosing radiation-induced trismus must be explained in detail, along with relevant references.<\/b>  The diagnosis of radiation-induced trismus was not part of the objectives of our study, and therefore, we did not include detailed criteria for its diagnosis.  \n<b>A key parameter in ORN is the specific radiation dose received by the affected region. For instance, the Dmean Vx doses at extraction sites are not reported.<\/b>  We did not measure the specific radiation doses, such as the Dmean Vx doses at the extraction sites, in our study. However, we acknowledge the importance of radiation dose as a key parameter in ORN and have included a discussion of its role and relevance in the progression of ORN in the manuscript.  \n<b>It would be beneficial to discuss the clinical and laboratory factors that can influence ORN development and treatment from all angles. Recently published reviews may provide useful insights.<\/b>  In our study, we have made an effort to enrich the discussion by including relevant clinical factors that could influence the development and treatment of ORN. \n<b>7. In Table 1, the tumor histological types and locations are quite heterogeneous, meaning the radiation doses received by different parts of the jaw also vary, which could affect the outcomes. This limitation should be explicitly addressed.<\/b> \n<b>Long-term follow-up processes in ORN management could be emphasized. In particular, the effects of patient compliance during long-term treatments, such as HBOT, should be discussed.<\/b> We have addressed this limitation by acknowledging the variability in radiation doses due to the heterogeneity of tumor histology and locations in the revised discussion. We have included a discussion on the importance of long-term follow-up in ORN management, emphasizing that patient compliance during extended treatments, such as HBOT, plays a crucial role in achieving optimal outcomes.  \n<b>The long-term effects of HBOT and any potential complications should also be addressed.<\/b>  We have added information on the long-term effects of HBOT, including potential complications.","URL":"https:\/\/f1000research.com\/articles\/13-1225\/v2#referee-comment-12956","order":2,"name":"referee-comment-12956","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.170239.r332802, Amaliya Amaliya, Universitas Padjadjaran, Bandung, West Java, 08 Nov 2024, version 1, 3 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/13-1225\/v1#referee-response-332802","order":3,"name":"referee-response-332802","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Chaima zitouni<\/b>; \n<i>Posted: 13 Dec 2024<\/i>; \n<b>Response to Reviewer Report by <\/b>\n<b>Amaliya Amaliya,<\/b> \n<b>Universitas Padjadjaran, Bandung, West Java, Indonesia<\/b> We sincerely thank Dr. Amaliya for the thoughtful review and valuable comments, and here are our detailed responses to the comments provided: \n<b>1. First of all, I would like to suggest a minor revision to the title. It would be better if the title also mentioned the type of the study. The authors defined the study as retrospective, but I may suggest it as a case-control study. Either it may be like Factors influencing osteoradionecrosis progression during hyperbaric oxygen therapy: A retrospective study or Factors influencing osteoradionecrosis progression during hyperbaric oxygen therapy: A case-control study.<\/b> \n<b>Author Response:&nbsp;<\/b>The initial title of the manuscript was \n<b>&quot;Factors influencing osteoradionecrosis progression during hyperbaric oxygen therapy: A retrospective study&quot;<\/b>, but this was rejected by the journal editors. They proposed the revised title, and we followed their recommendation.  \n<b>2. The introduction is too short, the authors only cite 2 articles in there. Please explain the current state of the knowledge, with references. Identify the knowledge gap that you wish to fill with your study. Author Response:&nbsp;<\/b>We have expanded the introduction to include a detailed explanation of the current state of knowledge with additional references and have clearly identified the knowledge gap our study aims to address.  \n<b>3. The result section is lacking demographic data\/table of the subjects.<\/b> \n<b>Author Response:&nbsp;<\/b>I have included a table to address the reviewer\u2019s concern and enhance the clarity of the results section.  \n<b>4. Did the authors adjust the collected data, for example for differences in age and gender?<\/b> \n<b>Author Response:&nbsp;<\/b>We have adjusted the collected data for potential differences in age and gender in our analysis. Regression analysis was applied to account for these factors and ensure that the results are not confounded by demographic variables.  \n<b>5. In the discussion, please explain the mechanism or at least biological plausibility for the factors associated or influencing the ORN progression, for example, hypertension, what is the explanation or biological plausibility.<\/b> \n<b>Author Response:&nbsp;<\/b>We have addressed the concern regarding the biological plausibility of factors influencing the progression of ORN, including hypertension.","URL":"https:\/\/f1000research.com\/articles\/13-1225\/v2#referee-comment-12957","order":4,"name":"referee-comment-12957","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}