After critically evaluating the literature, it appears clear that advanced
ORN requires aggressive surgical therapy, and it has become
increasingly evident that HBO alone has minimal if any
benefit in the treatment of advanced ORN. Additionally, as some
recent publications have suggested, HBO may not have a clear role
in the treatment of advanced ORN when a vascularized reconstruction
is used.4,33 The use of HBO in early and intermediate ORN remains
important because the benefit seems clear based on
numerous retrospective studies. The morbidity of HBO is minimal
including transient myopia, middle ear barotrauma and seizures.34
Absolute contraindication for HBO include optic neuritis, history of
bullous pulmonary disease (COPD) or congenital pulmonary
blebs