Studies have shown that hyperbaric oxygen therapy (HBOT) can increase bone mineral density (BMD) and enhance healing during distraction osteogenesis. Three studies on rabbits found that applying HBOT during the consolidation phase of limb lengthening significantly increased BMD compared to controls. A fourth study also found higher BMD in rabbits that received HBOT during distraction at different rates of 1-2 mm/day. HBOT may allow for more rapid bone distraction by promoting angiogenesis and new bone formation.

1. “The Effect of Hyperbaric Oxygen Therapy on Distraction Osteogenesis”Afnan A. Nassar, Sara A. Bukhari, Sereen A. Kattan, Shahinaz N. Simbawa¹, Jamila M. Ali Farsi ²Faculty of dentistry, King Abdulaziz University.¹ Dental Interns, Faculty of Dentistry King Abdulaziz University .² Associate Professor Department of Basic Oral and Clinical Sciences ,Faculty of Dentistry, King Abdulaziz University Hyperbaric Oxygen Therapy & Distraction Osteogenesis Chun Wang, et al. (2005), explored the effect of hyperbaric oxygen therapy (HBOT) on the early phase of tibial lengthening in established rabbit model. Twenty-four male rabbits underwent right tibial lengthening by 5 mm. Group 1 underwent 2.5 ATA hyperbaric oxygenation for 2 hours daily for 6 weeks postoperatively; group 2, for early 5 weeks (weeks 1–5), group 3, for late 5 weeks (weeks 2–6), and group 4 had no HBOT. Results showed that Significantly higher mean %BMDs were obtained for groups 1 and 2 than for groups 3 and 4.[4] Eralp, et al. (2007), also Investigated the effects of HBOT on distraction osteogenesis In a rabbit limb-lengthening model. They found that there was a statistically significant increase in BMD in the HBO group compared with that in the non-HBO group.[5] Fig . Anteroposterior radiograph of a rabbit tibia during the consolidation period. Salgado, et al. (2009), twenty-four animals were divided into four groups with distraction rates of 1 mm & 2 mm/day with & without HBOT. Results showed that groups that had distraction of 1 mm/day & 2 mm/day, those that underwent HBOT had significantly higher BMD than those without HBOT.[6] HyperbaricOxygen Therapy (HBOT) Hyperbaric oxygen therapy is defined by the Undersea and HyperbaricMedical Society (UHMS) as a treatment in which a patient intermittentlybreathes 100% oxygen while the treatment chamber is pressurizedto a pressure greater than sea level (1 atmosphere absolute,ATA).[1] Types: Monoplace chamber or multiplace chambers. Distraction Osteogenesis (DO) Distraction Osteogenesis can be defined as the technique in which bone generation and soft tissue proliferation are achieved by means of gradual, controlled distraction of pre-existing native bone. History: The first who reported a method for expansion of bone by Distraction osteogenesis is Codivilla (1905) who gradually lengthened a femur. Abbot (1927) contributed in the improvement of Codivilla method by incorporating pins instead of casts used by Codivilla. Ilizarov a Russian orthopedician was the one who popularized DO; during the period between 1950-1970 Ilizarov conceptualized the basis of DO. [2] Clinically, distraction osteogenesis consists of five sequential periods: 1- Osteotomy. 2- Latency, the duration from bone division to the onset of traction. 3- Distraction, the time when gradual traction is applied and distraction regenerate is formed. 4- Consolidation, the period that allows maturation and corticalization of the regenerate after traction forces are discontiued. 5- Remodeling, which extends from the initial application of full functional loading to the completion of regenerate bone remodeling.[3] Physiology of Hyperbaric Oxygen: [1] Normal blood flow [2] Restricted blood flow (occlusion) [3]Hyperbaric oxygenation Conclusion Studies showed that HBOT increases BMD of distracted bone and enhances the process of healing in distraction osteogenesis, allowing for more rapid distraction . References: 1. Hampson NB, ed. HyperbaricOxygenTherapy: 1999 Committee report. Kensington MD, Undersea and Hyperbaric Medical Society, 1999. 2. H. AL Rashdan, Maxillofacial Distraction Osteogenesis. Smile dental journal 2010. 3. Samchacuv M.L. et al. (2001). Craniofacial Distraction Osteogenesis. Biologic basis of New Bone Formation Under the Influence of Tension Stress : Mosby. 4. I-Chun Wang, et al. Early Administration of Hyperbaric Oxygen Therapy in Distraction Osteogenesis: A Quantitative Study in New Zealand Rabbits. J Trauma,injery,infection & critical care. 2005. 5. L.Eralp, et.al: Effects of Hyperbaric Oxygen Therapy on Distraction Osteogenesis 2007. 6. C.J. Salgado, et. al: Effects of hyperbaric oxygen therapy on an accelerated rate of mandibular distraction osteogenesis. Journal of Plastic, Reconstructive & Aesthetic Surgery 2009.