Stage II disease represents larger and deeper areas of bone
resorption. Cortical and medullary bone are involved and the
mucosal or cutaneous areas of breakdown are moderate in size.
This stage of ORN is approached with antibiotics, trans-oral
debridement or sequestrectomy, and HBO therapy (20 dives preoperatively
and 10 post-operative dives). All necrotic bone is debrided
to a base of bleeding bone and a primary mucosal closure is
performed. If the mucosa is unable to be closed primarily, a soft tissue
flap can be utilized for coverage. All patients receive an additional
10 dives of HBO post-operatively. Patients that develop
wound problems or repeat bone exposure are then treated with
an aggressive surgical extirpation of all diseased hard and soft tissue
and an immediate reconstruction with a well-vascularized free
tissue transfer. Again, this approach differs from Marx’s protocol in
that only 20 pre-operative dives are performed prior to surgical
debridement. Marx’s Stage II protocol utilizes up to 60 total dives
pre- and post-operatively.