Hello, I am Dr. Chaeyeon Lee of EU Oral and Maxillofacial Surgery.
Among the questions we hear most often from patients preparing for orthognathic (double-jaw) or facial contouring surgery are: "How long will it take for the swelling to go down and for me to return to daily life?" and "Is there anything that can reduce the risk of complications?"
Orthognathic surgery is a highly demanding procedure in which the jawbones are precisely cut and repositioned. Cutting and moving the bone inevitably involves extensive periosteal elevation, damage to small blood vessels, and retraction of the soft tissues. As a result, the early postoperative period can bring several recovery challenges, including acute tissue hypoxia, significant swelling, delayed healing of mucosal wounds, and reduced sensation in sensory nerves such as the inferior alveolar nerve.
Hyperbaric Oxygen Therapy (HBOT), which our clinic provides to patients after surgery, helps address these issues. Below, I will explain how it supports a faster and more stable recovery.
1. The Basic Principle of HBOT: "Delivering Oxygen Directly to Tissue, Even When Blood Vessels Are Narrowed"
When we breathe at normal atmospheric pressure (1 atmosphere), oxygen is carried in the blood bound to hemoglobin inside red blood cells. However, in areas such as a surgical site, where blood vessels are damaged and compressed by swelling so that microcirculation is cut off, even red blood cells have difficulty passing through.
HBOT is a treatment in which the patient breathes 100% medical-grade oxygen inside a pressurized chamber at 2.0 ATA (twice normal atmospheric pressure) or higher. According to Henry's Law, oxygen then dissolves directly into plasma, the liquid component of the blood, and the concentration of dissolved oxygen in the plasma rises to 15–20 times its normal level.
Through simple physical diffusion alone, this high concentration of oxygen reaches areas red blood cells cannot—the damaged osteotomy lines of the jawbone, the elevated oral mucosa, and the tissue surrounding the nerves—promptly relieving tissue ischemia.
2. Clinical Evidence: A 64% Reduction in Wound Healing Time After Facial Surgery
Regarding soft-tissue healing in the facial region, a case-control study of facelift patients published in Aesthetic Surgery Journal Open Forum on 2023 clearly demonstrates the strong wound-healing effect of HBOT.
• Significantly shorter wound healing time: In the group that received HBOT after surgery, complete wound healing took an average of 13.3 days, compared with an average of 36.9 days in the control group that received standard care alone (P < .001). This represents a reduction in healing time of approximately 64%.
• Reduced swelling and bruising, and patient satisfaction: HBOT lowers microvascular permeability, preventing fluid leakage, and supports lymphatic circulation, helping facial swelling and bruising subside more quickly. In the study's survey, the majority of patients also reported high satisfaction with the reduction in swelling and the overall speed of recovery.
In orthognathic surgery as well, how quickly the intraoral incisions and the soft tissues around the jaw stabilize largely determines the quality of early recovery. HBOT can substantially accelerate this soft-tissue regeneration cycle, helping patients return to daily life sooner.
3. Prevention and Non-Surgical Healing of Palatal Perforation and Fistula After Segmental Osteotomy
In a segmental Le Fort I osteotomy, in which the maxilla is divided into several segments to expand the dental arch or adjust the angle of the front teeth, strong tension is placed on the palatal mucosa. In rare cases, this can cause the mucosa to tear or ulcerate. If it does not heal in time, it can progress to an oronasal fistula—an opening between the mouth and the nasal cavity—which may require a secondary flap surgery.
A case report published in JPRAS Open in 2024 showed a remarkable tissue-regenerative effect of HBOT. In a patient who developed a severe mucosal ulcer exposing the palatal bone and nasal floor after a segmental maxillary osteotomy, 14 days of daily HBOT promoted the growth of granulation tissue and restored blood supply to the exposed bone. Complete epithelialization and healing were achieved without surgical revision and without fistula formation.
• Infection control and prevention of osteomyelitis: The high-pressure oxygen environment suppresses the growth of harmful anaerobic bacteria that naturally reside in the mouth and maximizes the phagocytic activity of white blood cells (neutrophils), helping to prevent infection around the fixation plates at the osteotomy site and bone necrosis before they occur.
4. Promoting Bone Union and Supporting Recovery of the Sensory Nerve (Inferior Alveolar Nerve)
The final two pillars of a successful orthognathic surgery are "how solidly the bone heals" and "how fully sensation in the chin and lips returns."
Promoting bone healing
The enzymes involved in collagen synthesis in osteoblasts, the bone-forming cells, require a high partial pressure of oxygen. HBOT stimulates the expression of bone morphogenetic proteins (BMP) and the formation of new blood vessels (VEGF), accelerating bone matrix formation and mineralization between the bone segments. This plays a key role in increasing the structural stability of the jaw after surgery and reducing relapse.
Relieving compression injury of the inferior alveolar nerve (IAN) and numbness
During lower-jaw surgery, the nerve may be stretched, or swelling of the surrounding soft tissue may raise the pressure inside the nerve, resulting in reduced sensation or numbness. HBOT helps rapidly reduce endoneurial edema and supports the synthesis of neurotrophic factors, promoting axonal regeneration and myelination of the injured sensory nerve.
Closing
References
Yang C, et al. "Synergistic benefits of hyperbaric oxygen therapy for postoperative palatal oro-nasal fistula following segmental Le Fort 1 osteotomy." JPRAS Open. 2024 Jun 13;41:225–229. doi:10.1016/j.jpra.2024.05.015
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