What is Hill Country Wound Care And Hyperbarics?

Specialized treatment for chronic, acute, and hard-to-heal wounds in San Antonio, including advanced hyperbaric oxygen therapy to accelerate healing.

What is osteoradionecrosis (ORN)?

Osteoradionecrosis is a serious complication of radiation therapy for head and neck cancers. Radiation damages blood vessels in the jawbone, reducing blood flow and oxygen delivery. Over time, this can cause bone tissue to die and become exposed in the mouth. ORN can develop months or even years after radiation treatment ends.

What are the symptoms of osteoradionecrosis?

Common symptoms include exposed jawbone that persists for more than 3 months, pain or swelling in the jaw, loose teeth, numbness or heaviness in the jaw, difficulty opening the mouth, foul-smelling breath or taste, and non-healing extraction sites. If you've had head and neck radiation and notice any of these symptoms, seek specialist evaluation promptly.

How does hyperbaric oxygen therapy (HBOT) treat ORN?

HBOT increases oxygen delivery to radiation-damaged jawbone by up to 15-fold. This stimulates new blood vessel growth (angiogenesis), reduces scarring in damaged vessels, enhances white blood cell activity to control infection, and supports bone and soft tissue healing. HBOT is the gold-standard adjunctive therapy for ORN and is covered by Medicare for this indication.

How many HBOT treatments will I need for ORN?

The standard Modified Marx Protocol involves 30 daily HBOT sessions initially, followed by surgical evaluation. If surgery is needed to remove necrotic bone, an additional 10+ HBOT sessions are typically recommended post-operatively. Total treatment ranges from 30-60 sessions depending on disease severity and whether surgery is required.

Is HBOT for ORN covered by insurance?

Yes — Medicare and most major insurance plans cover HBOT for osteoradionecrosis of the jaw. Our care coordinators verify your benefits and obtain prior authorization before treatment begins so you have no financial surprises.

Do I need a referral for HBOT treatment?

Self-referrals are accepted — no doctor's note required. However, we recommend coordination with your radiation oncologist, oral surgeon, or dentist for comprehensive care. We'll obtain necessary medical records and imaging to develop your treatment plan.

How soon can I start HBOT after being diagnosed with ORN?

Most patients are seen within 48 hours of their initial call. After your physician evaluation, HBOT can typically begin within 1-2 weeks, pending insurance authorization. If you have severe pain, infection, or jaw fracture, call us immediately for expedited scheduling.

Can ORN be prevented?

Yes — preventive HBOT (20-30 sessions before dental extractions or oral surgery in irradiated jawbone) significantly reduces ORN risk. If you've had head and neck radiation and need dental work, talk to your dentist and radiation oncologist about preventive HBOT before any invasive procedures.

Condition We Treat · San Antonio

OsteoradionecrosisRadiation-InducedJawbone Damage Treatment

Osteoradionecrosis (ORN) is a serious complication of radiation therapy for head and neck cancers. At Hill Country Wound Care & Hyperbarics, our board-certified hyperbaric physicians deliver the Modified Marx Protocol — 30-60 HBOT sessions with surgical coordination — to restore blood flow, support bone healing, and improve quality of life.

HBOT-Certified PhysiciansMedicare AcceptedModified Marx ProtocolSeen Within 48 Hours

30-60

HBOT sessions in the Modified Marx Protocol for ORN

↑15x

Increase in oxygen delivery to damaged bone with HBOT

Significant improvement

Reported in pain, healing, and quality of life after completing HBOT protocol

Physician Referrals

Refer a patient with ORN

Why It Matters

Radiation Saves Lives.But It Can Damage Jawbone.

Radiation therapy for head and neck cancers targets cancer cells — but it can also injure healthy blood vessels in the jawbone. Over time, this reduced blood flow causes bone tissue to die, leading to exposed bone, infection, pain, and fractures.

Once ORN develops, the jawbone cannot heal on its own. Without restoring oxygen-rich blood flow through HBOT, controlling infection, and surgically removing dead bone when needed, ORN worsens — leading to chronic pain, tooth loss, jaw fractures, and severely reduced quality of life.

Warning Signs

Seek specialist evaluation promptly

Exposed jawbone that persists for more than 3 months

Pain, swelling, or infection in the jaw area

Loose teeth or tooth loss without dental disease

Numbness or heaviness in the jaw (paresthesia)

Difficulty opening the mouth (trismus)

Foul-smelling breath or taste that won't resolve

Jaw fractures or weakening without trauma

Non-healing extraction sites or oral surgical wounds

Your Healing Plan

Your Personalized ORN Treatment Plan

Comprehensive Evaluation

Our physician-led team assesses your radiation history, oral health, and symptoms. We coordinate imaging (CT, MRI, or panoramic X-ray) and clinical examination to determine the stage and extent of osteoradionecrosis.

Hyperbaric Oxygen Therapy (HBOT) — Primary Treatment

HBOT is the gold-standard adjunctive therapy for ORN. By breathing 100% oxygen in a pressurized chamber, you increase oxygen delivery to damaged jawbone by up to 15-fold. This stimulates new blood vessel growth (angiogenesis), reduces scarring in radiation-damaged vessels, and supports bone healing. Initial protocol: 30 daily HBOT sessions before surgical evaluation.

Surgical Coordination

After 30 HBOT sessions, our team coordinates with your oral surgeon to evaluate whether surgical removal of necrotic bone is needed. If surgery is required, an additional 10+ HBOT sessions post-operatively support healing and reduce complications.

Advanced Wound Management

For patients with exposed bone or oral wounds, we provide specialized wound care including antimicrobial rinses, gentle debridement when appropriate, and protective dressings to support soft tissue healing.

Infection Control

If infection is present, we coordinate targeted antibiotic therapy and antimicrobial protocols to control bacterial load while HBOT works to restore oxygenation and blood flow to the damaged bone.

Pain & Symptom Management

Our team addresses pain, trismus (limited jaw opening), and nutritional challenges. We coordinate with physical therapists, nutritionists, and pain specialists to support your quality of life throughout treatment.

Multidisciplinary Collaboration

ORN care requires coordination across specialties. We work with your radiation oncologist, oral surgeon, dentist, and primary care provider to ensure every aspect of your recovery is aligned and progressing.

Why Hill Country

San Antonio's Largest
Physician-Led HBOT Program

From board-certified hyperbaric physicians trained in the Modified Marx Protocol to three convenient locations and insurance coordination, we deliver comprehensive ORN care — at a fraction of hospital costs.

HBOT-Certified Physicians

Our board-certified hyperbaric physicians are experienced in the Modified Marx Protocol for ORN — delivering 30-60 HBOT sessions with surgical coordination when needed.

Largest Private Wound Care Network in San Antonio

Three convenient locations with state-of-the-art hyperbaric chambers, offering faster access than hospital-based programs.

Insurance Accepted

Medicare and most major insurances cover HBOT for osteoradionecrosis. Our care coordinators handle prior authorizations and benefit verification before treatment begins.

Comprehensive, Compassionate Care

From your first visit through HBOT completion, our physician-led team provides personalized support, symptom management, and coordination with your cancer care team.

Ready to start your healing journey? Our team is here to help.

From Our Blog

View all articles

Hyperbaric

The Benefits of Hyperbaric Oxygen Therapy: Accelerating Healing and Recovery

HBOT increases oxygen delivery to damaged tissue by up to 15-fold — stimulating new blood vessel growth, enhancing immune response, and supporting healing in radiation-damaged bone and soft tissue.

4 min readRead more

Patient Education

What to Expect During Your First Hyperbaric Oxygen Therapy Session

Learn what happens during HBOT treatment — from the pressurized chamber experience to safety protocols, session duration, and how our team supports you through all 30-60 treatments.

5 min readRead more

Wound Care

What Sets Hill Country Apart: Quality, Safety, and Experience in Every Visit

ORN requires specialized, physician-led HBOT care — the Modified Marx Protocol with surgical coordination. Learn why Hill Country's model delivers better outcomes and patient satisfaction.

4 min readRead more

Osteoradionecrosis (ORN) FAQs

Have more questions? Visit our full FAQ page or explore our articles.

Greater San Antonio

Experiencing Jawbone Pain After Radiation?

Osteoradionecrosis requires specialized HBOT treatment. Our board-certified physicians deliver the Modified Marx Protocol at three convenient San Antonio locations — most patients are seen within 48 hours.

(210) 610-8154

Osteoradionecrosis (ORN) Treatment in San Antonio, TX

Hill Country Wound Care provides physician-led, specialized care for osteoradionecrosis (ORN) in San Antonio, TX. Our board-certified hyperbaric physicians deliver the Modified Marx Protocol — 30-60 Hyperbaric Oxygen Therapy (HBOT) sessions with surgical coordination — for patients with radiation-induced jawbone damage following head and neck cancer treatment.

Understanding Osteoradionecrosis

Osteoradionecrosis is a serious complication of radiation therapy for head and neck cancers. Radiation damages blood vessels in the jawbone, causing scarring and narrowing that reduces blood flow and oxygen delivery. Without adequate oxygen, bone tissue dies and becomes exposed in the mouth. ORN can develop months or years after radiation ends, causing pain, infection, tooth loss, jaw fractures, and severely reduced quality of life.

The Modified Marx Protocol for ORN Treatment

Our treatment follows the evidence-based Modified Marx Protocol: 1) Initial HBOT Phase: 30 daily hyperbaric oxygen sessions to increase oxygen delivery to damaged bone, stimulate new blood vessel growth, and reduce scarring. 2) Surgical Evaluation: After 30 sessions, our team coordinates with your oral surgeon to determine if surgical removal of necrotic bone is needed. 3) Post-Surgical HBOT: If surgery is performed, an additional 10+ HBOT sessions support healing and reduce complications. Total treatment: 30-60 sessions depending on severity.

Hyperbaric Oxygen Therapy for Osteoradionecrosis

HBOT is the gold-standard adjunctive therapy for ORN, covered by Medicare and most major insurances. By breathing 100% oxygen in a pressurized chamber (up to 3 times normal pressure), patients increase oxygen delivery to damaged jawbone by up to 15-fold. This hyper-oxygenated blood stimulates angiogenesis (new blood vessel growth), reduces vessel scarring, enhances white blood cell activity to control infection, and supports bone and soft tissue healing. HBOT is a critical tool that has been proven to improve healing rates, reduce pain, and prevent disease progression in ORN patients.

Why Choose Hill Country for ORN Treatment

San Antonio's largest private wound care and hyperbarics network. Board-certified hyperbaric physicians experienced in the Modified Marx Protocol. Three convenient locations with state-of-the-art chambers. Medicare and insurance accepted with prior authorization handled by our care coordinators. Most patients seen within 48 hours. Comprehensive, compassionate support from evaluation through treatment completion.