Thanks Christine,

I was able to search for the Marx Protocol, and found some more information;
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Marx Protocol for ORN and Tooth Extraction
The most widely accepted and extensively documented indication for hyperbaric oxygen in
chronic radiation injury is its application in the treatment and prevention of radiation necrosis of
the mandible. Robert E. Marx, DDS developed the following original staging system for
classifying and treatment mandibular osteoradionecrosis (ORN) and treating former head and
neck cancer patients prior to extraction of teeth.
Benefits of HBO2
� Vascular improvement
� Expedited healing of ORN
� Better tolerance to surgical wounding prior to oral surgery
� Prevention of mandibular necrosis as a result of tooth extraction
� Freedom from pain
� Restoration of mandibular function and wearing of dental appliances, if needed
� Maintenance of intact mucosa and skin over all bone
Stage I ORN/Extraction
Patients with exposed bone who have no serious manifestations of those in Stage III. Begin with
30 HBO2 treatments with no debridement or only minor bony debridement. If patient progresses,
give 10 additional HBO2 treatments.
Stage II ORN
If not progressing, Stage II patients should receive surgical debridement and 30 HBO2 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 HBO2 treatments prior to resection
followed by 10 post-resection treatments.
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... and thanks for the good wishes.