Kuti mutsitse kapena kusindikiza tsamba ili m'chinenero china, sankhani chinenero chanu kuchokera pa menyu otsika pamwamba kumanzere koyamba.

IAOMT Position Paper pa Human Jawbone Cavitations

Wapampando wa Komiti ya Jawbone Pathology: Ted Reese, DDS, MAGD, NMD, FIAOMT

Karl Anderson, DDS, MS, NMD, FIAOMT

Patricia Berube, DMD, MS, CFMD, FIAOMT

Wolemba Jerry Bouquot

Teresa Franklin, PhD

Jack Kall, DMD, FAGD, MIAOMT

Cody Kriegel, DDS, NMD, FIAOMT

Sushma Lavu, DDS, FIAOMT

Tiffany Shields, DMD, NMD, FIAOMT

Mark Wisniewski, DDS, FIAOMT

Komitiyi ikufuna kupereka chiyamikiro chathu kwa Michael Gossweiler, DDS, MS, NMD, Miguel Stanley, DDS ndi Stuart Nunally, DDS, MS, FIAOMT, NMD chifukwa cha kutsutsa kwawo kwa pepalali. Tikufunanso kuzindikira zopereka zamtengo wapatali ndi khama lomwe Dr. Nunnally adalemba polemba zolemba za 2014. Ntchito yake, khama ndi machitidwe ake zidapereka msana wa pepala losinthidwali.

Kuvomerezedwa ndi IAOMT Board of Directors September 2023

M'ndandanda wazopezekamo

Introduction

History

Matendawa

Cone beam computed tomography (CBCT)

ultrasound

Biomarkers ndi Histological Examination

Zolinga Zosintha Zolinga Zowunika

Zithunzi

Acupuncture Meridian Assessment

Zowopsa

Zotsatira za Systemic ndi Zachipatala

Njira Zochiritsira

Njira Zina Zochiritsira

Mawuwo

Zothandizira

Zakumapeto I Zotsatira za IAOMT Survey 2

Zakumapeto II Zotsatira za IAOMT Survey 1

Zowonjezera III Images

Chithunzi 1 Fatty degenerative osteonecrosis of the jawbone (FDOJ)

Chithunzi cha 2 Cytokines mu FDOJ poyerekeza ndi Healthy Controls

Chithunzi 3 Njira yopangira opaleshoni ya retromolar FDOJ

Chithunzi 4 Curettage ndi X-ray yofananira ya FDOJ

Makanema Makanema tatifupi a opaleshoni nsagwada odwala

MAU OYAMBA

M'zaka khumi zapitazi pakhala chidziwitso chowonjezeka pakati pa anthu ndi opereka chithandizo chamankhwala cha mgwirizano pakati pa thanzi la mkamwa ndi machitidwe . Mwachitsanzo, matenda a periodontal ndi chiopsezo cha matenda a shuga komanso matenda a mtima . Ubale womwe ungakhale wotsatira komanso wofufuzidwa mochulukirachulukira wawonekeranso pakati pa matenda a nsagwada ndi thanzi komanso nyonga zonse za munthu . Kugwiritsira ntchito njira zamakono zamakono monga cone-beam computed tomography (CBCT) zathandiza kwambiri pozindikira matenda a nsagwada, zomwe zapangitsa kuti athe kuwunika bwino komanso kuti athe kuwunika bwino ntchito za opaleshoni. Malipoti asayansi, ma docudramas ndi malo ochezera a pa Intaneti awonjezera kuzindikira kwa anthu za matendawa, makamaka pakati pa anthu omwe akudwala matenda osadziwika bwino a mitsempha kapena machitidwe omwe amalephera kuyankha chithandizo chamankhwala kapena mano.

International Academy of Oral Medicine and Toxicology (IAOMT) idakhazikitsidwa pa chikhulupiliro chakuti sayansi iyenera kukhala maziko omwe njira zonse zowunikira ndi chithandizo zimasankhidwa ndikugwiritsidwa ntchito. Ndizofunika kwambiri m'maganizo kuti ife 1) timapereka izi ku 2014 IAOMT Jawbone Osteonecrosis Position Paper, ndi 2) tikupempha, kutengera mbiri yakale, dzina lolondola mwasayansi komanso lachipatala la matendawa, makamaka, Chronic Ischemic Medullary Disease. wa Chibwano (CIMDJ). CIMDJ imalongosola vuto la fupa lomwe limadziwika ndi kufa kwa zigawo za cell of cancellous bone, chachiwiri mpaka kusokonezeka kwa magazi. M'mbiri yake yonse, zomwe tikuzitchula kuti CIMDJ zatchulidwa ndi mayina ambiri ndi zilembo zomwe zalembedwa mu Table 1 ndipo zidzakambidwa mwachidule pansipa.

Cholinga ndi cholinga cha Academy iyi ndi pepala ndi kupereka sayansi, kafukufuku, ndi zochitika zachipatala kwa odwala ndi madokotala kuti apange zisankho zodziwika bwino poganizira zilonda za CIMDJ, zomwe nthawi zambiri zimatchedwa nsagwada cavitations. Pepalali la 2023 linapangidwa mogwirizana ndi akatswiri azachipatala, ofufuza komanso katswiri wodziwika bwino wa matenda a nsagwada, Dr. Jerry Bouquot, potsatira kuwunika kwa nkhani zopitilira 270.

POYAMBA

Palibe fupa lina lomwe lingathe kuvulala ndi matenda aakulu monga nsagwada. Ndemanga ya zolemba zokhudzana ndi mutu wa jawbone cavitations, (ie, CIMDJ) zikuwonetsa kuti matendawa adapezeka, adachiritsidwa ndikufufuzidwa kuyambira m'ma 1860. Mu 1867, Dr. HR Noel anapereka nkhani yamutu wakuti Phunziro pa caries ndi necrosis ya mafupa ku Baltimore College of Dental Surgery, ndipo mu 1901 cavitations nsagwada zafotokozedwa motalika ndi William C. Barrett m'buku lake lotchedwa, Oral Pathology and Practice: A Textbook for the Use of Students in Dental Colleges and Handbook for Dental Practitioners . GV Black, yemwe nthawi zambiri amatchedwa tate wa madokotala amakono a mano, anaphatikizapo gawo m'buku lake la 1915, Special Dental Pathology , kufotokoza 'mawonekedwe achizolowezi ndi chithandizo cha' zomwe adazitcha jawbone osteonecrosis (JON) .

Kafukufuku wokhudza nsagwada za nsagwada anaoneka kuti waima mpaka cha m’ma 1970 pamene ena anayamba kufufuza mutuwo, pogwiritsa ntchito mayina ndi zilembo zosiyanasiyana, komanso kufalitsa zambiri zokhudza nkhaniyi m’mabuku amakono a matenda a m’kamwa . Mwachitsanzo, mu 1992 Bouquot et al adawona kutupa kwa intraosseous kwa odwala omwe ali ndi ululu wopweteka kwambiri wa nkhope (N = 135) ndipo adapanga mawu akuti 'Neuralgia-inducing Cavitational Osteonecrosis', kapena NICO. Ngakhale Bouquot et al sananenepo za etiology ya matendawa, adatsimikiza kuti zilondazo zidapangitsa kuti nkhopeyo ikhale ndi neuralgia yokhala ndi mawonekedwe apadera amderali: mapangidwe amkati amkati ndi mafupa amtundu wautali wokhala ndi machiritso ochepa. Pakafukufuku wa odwala omwe ali ndi trigeminal (N = 38) ndi neuralgia ya nkhope (N = 33), Ratner et al, adawonetsanso kuti pafupifupi odwala onse anali ndi mitsempha mu fupa la alveolar ndi nsagwada. Mabowo, nthawi zina opitilira 1 centimita m'mimba mwake, anali pamalo omwe adachotsedwapo kale ndipo nthawi zambiri sankawoneka ndi ma x-ray.

Mawu ena osiyanasiyana omwe timadziwika kuti CIMDJ alipo m'mabuku. Izi zalembedwa mu Table 1 ndipo zakambidwa mwachidule apa. Adams et al adapanga mawu akuti Chronic Fibrosing Osteomyelitis (CFO) mu pepala la 2014. Pepala laudindoli lidachitika chifukwa cha gulu la akatswiri ambiri ochokera m'magawo a Oral Medicine, Endodontics, Oral Pathology, Neurology, Rheumatology, Otolaryngology, Periodontology, Psychiatry, Oral and Maxillofacial Radiology, Anesthesia, General Dentistry, Internal Medicine, ndi Painternal Medicine. . Cholinga cha gululi chinali kupereka njira zosiyanasiyana zochizira matenda okhudzana ndi mutu, khosi, ndi nkhope. Kupyolera mu kuyesetsa kwa gululi, kufufuza mabuku ambiri ndi kuyankhulana kwa odwala, njira yapadera yachipatala inatulukira, yomwe iwo ankaitcha CFO. Iwo adanena kuti matendawa nthawi zambiri sadziwika chifukwa cha zovuta zake ndi zina zadongosolo. Gululi lidawonetsa kulumikizana komwe kungachitike pakati pa matendawa ndi zovuta zokhudzana ndi thanzi komanso kufunikira kwa gulu la madotolo kuti azindikire ndikuchiritsa wodwalayo.

Chibwano cavitational zotupa akhala anaonanso ana. Mu 2013, Obel et al adalongosola zotupa mwa ana ndipo adapanga mawu akuti Juvenile Mandibular Chronic Osteomyelitis (JMCO). Gululi linanena kuti angagwiritsidwe ntchito m'mitsempha (IV) bisphosphonates monga chithandizo kwa anawa. Mu 2016 Padwa et al adafalitsa kafukufuku wofotokoza za focal sterile inflammatory osteitis m'mafupa a nsagwada za ana. Iwo adatcha lesion Pediatric Chronic Nonbacterial Osteomyelitis (CNO).

Kuyambira 2010, Dr. Johann Lechner, wolemba mabuku ndi wofufuza wofalitsidwa kwambiri pa zilonda za nsagwada cavitational, ndi ena akhala akufufuza za zilondazi ndi kupanga cytokine, makamaka kutupa kwa cytokine RANTES (yomwe imadziwikanso kuti CCL5). Dr. Lechner wagwiritsa ntchito mawu osiyanasiyana pofotokoza zilondazi zomwe zakhala zikuphatikizapo NICO yotchulidwa kale komanso Aseptic Ischemic Osteonecrosis mu Jawbone (AIOJ), ndi Fatty Degenerative Osteonecrosis ya Jawbone (FDOJ) . Malongosoledwe ake/chizindikiro chake chimatengera mawonekedwe athupi komanso/kapena macroscopically pathological condition yomwe imawonedwa mwachipatala kapena intraoperatively.

Panopa pakufunika kufotokozera nsagwada zina zomwe zadziwika posachedwa zomwe ndizosiyana ndi mutu wa pepalali koma zikhoza kukhala zosokoneza kwa omwe akufufuza zotupa za cavitational. Izi ndi zotupa za mafupa a nsagwada zomwe zimachitika chifukwa chogwiritsa ntchito mankhwala. Zotupazi zimadziwika bwino kwambiri chifukwa cha kutaya magazi ndi kuphwanya kwa mafupa osalamulirika. Zotupa izi zatchedwa Oral Ulceration with Bone Sequestration (OUBS) ndi Ruggiero et al papepala la American Association of Oral and Maxillofacial Surgeons (AAOMS), komanso Palla et al, pakuwunika mwadongosolo. Popeza vutoli likugwirizana ndi kugwiritsa ntchito mankhwala amodzi kapena angapo, IAOMT ndi ya maganizo kuti mtundu uwu wa zilonda umafotokozedwa bwino monga Osteonecrosis yokhudzana ndi Mankhwala a Jaw (MRONJ). MRONJ sidzakambidwa m'nkhaniyi chifukwa etiology ndi njira zochiritsira ndizosiyana ndi zomwe tikuzitcha CIMDJ, ndipo zakhala zikuphunziridwa mozama .

KUDZIWA

Kugwiritsidwa ntchito kofala kwa Cone-beam computed tomography (CBCT) radiographs ndi madokotala ambiri a mano kwapangitsa kuti kuchulukidwe kwa ma intramedullary cavitations omwe timawatcha kuti CIMDJ, ndipo omwe poyamba ankanyalanyazidwa ndipo motero ananyalanyazidwa. Tsopano kuti zotupa izi ndi anomalies zambiri kuzindikiridwa mosavuta, umakhala udindo wa ntchito mano kudziwa matenda ndi kupereka malangizo mankhwala ndi chisamaliro.

Kuyamikira ndi kuzindikira kukhalapo kwa CIMDJ ndiye poyambira kumvetsetsa. Mosasamala kanthu za mayina ambiri ndi ma acronyms omwe amagwirizanitsidwa ndi matenda, kukhalapo kwa necrotic, kapena kufa kwa fupa mu medullary chigawo cha nsagwada kumakhazikitsidwa bwino.

Akamachitidwa opaleshoni, zolakwika za mafupa izi zimawonekera m'njira zambiri. Madokotala ena amanena kuti zotupa zopitirira 75% zimakhala zopanda kanthu kapena zodzaza ndi minofu yofewa, yotuwira-bulauni komanso yopanda mamineralized/granulomatis, yomwe nthawi zambiri imakhala ndi mafuta achikasu (mafupa amafuta) omwe amapezeka m'malo osokonekera okhala ndi mafupa ozungulira. Ena amafotokoza za kukhalapo kwa ma cavitations okhala ndi kachulukidwe kosiyanasiyana kopitilira muyeso komwe kumatseguka, kumawoneka ngati zomangira zokhala ndi ulusi wakuda, bulauni kapena imvi. Enanso amafotokoza kusintha kwakukulu komwe kumafotokozedwa mosiyanasiyana monga "gritty", "monga utuchi", "zobowo", ndi "zowuma" zomwe nthawi zina zimakhala zolimba ngati zibowo zolimba ngati dzino. Pakufufuza kwa histological, zilondazi zimawoneka mofanana ndi necrosis yomwe imapezeka m'mafupa ena a thupi ndipo imakhala yosiyana kwambiri ndi osteomyelitis (Onani Chithunzi 1). Zithunzi zowonjezera zosonyeza matenda a CIMDJ, ena omwe ali owoneka bwino, akuphatikizidwa mu Zowonjezera III kumapeto kwa chikalatachi.

Chithunzi 1 Zithunzi za CIMDJ zotengedwa ku cadaver

Monga madokotala ena azachipatala, madokotala amagwiritsira ntchito njira yokonzekera yomwe imagwiritsa ntchito njira ndi njira zosiyanasiyana kuti azindikire zotupa za cavitational. Izi zingaphatikizepo kuyezetsa thupi komwe kumaphatikizapo kuwerengera mbiri yaumoyo, kuwunika zizindikiro, kupeza madzi amadzi am'thupi kuti akayezetse m'ma labotale, ndikupeza zitsanzo za minyewa ya biopsy ndi kuyesa kwa tizilombo toyambitsa matenda (ie, kuyezetsa kukhalapo kwa tizilombo toyambitsa matenda). Tekinoloje zofananira, monga CBCT zimagwiritsidwanso ntchito nthawi zambiri. Odwala omwe ali ndi vuto lovuta lomwe silimatsatiridwa nthawi zonse kapena kugwirizana ndi momwe zizindikiro zimakhalira, njira yodziwira matenda ingafunike kusanthula mwatsatanetsatane zomwe poyamba zingapangitse kuti azindikire zosiyana. Mafotokozedwe achidule a zingapo mwa njira zodziwira matenda aperekedwa pansipa.

Cone beam computed tomography (CBCT)

Njira zodziwira matenda zomwe zinafotokozedwa kale mu 1979 ndi Ratner ndi anzake, pogwiritsa ntchito digito palpation ndi kupsyinjika, jekeseni wamankhwala am'deralo, kulingalira za mbiri yachipatala ndi malo a ululu wowawa ndizothandiza pozindikira ma cavitations a nsagwada. Komabe, ngakhale kuti zina mwa zilondazi zimayambitsa kupweteka, kutupa, zofiira komanso kutentha thupi, zina sizitero. Chifukwa chake, muyeso wokhazikika, monga kujambula nthawi zambiri ndikofunikira.

Ma cavitations nthawi zambiri sazindikirika pamakanema amtundu wa 2-D monga, periapical ndi panoramic) omwe amagwiritsidwa ntchito kwambiri popanga mano. Ratner ndi anzake awonetsa kuti 40% kapena kuposa fupa liyenera kusinthidwa kuti liwonetse kusintha, ndipo izi zimathandizidwa ndi ntchito yapambuyo pake, ndipo zikuwonetsedwa mu Chithunzi 2. Izi zikugwirizana ndi kuchepa kwachibadwidwe kwa 2-D kujambula komwe kumayambitsa kupangika kwapamwamba. za mapangidwe a anatomical, masking madera osangalatsa. Pankhani ya zolakwika kapena matenda, makamaka mu mandible, kubisala kwa fupa lolimba la cortical pamapangidwe apansi kungakhale kofunikira. Chifukwa chake, njira zamakono zojambulira zaukadaulo monga CBCT, Tech 99 scans, imaging resonance imaging (MRI), kapena trans-alveolar ultrasound sonography (CaviTAU™®) ndizofunikira.

Mwa njira zosiyanasiyana zowonetsera zomwe zilipo, CBCT ndi chida chodziwika bwino chomwe chimagwiritsidwa ntchito ndi madokotala a mano omwe akukhudzidwa ndi matenda kapena kuchiza ma cavitations, choncho ndizomwe tidzakambirana mozama. Mwala wapangodya waukadaulo wa CBCT ndi kuthekera kwake kuwona chotupa cha chidwi mu miyeso ya 3 (kutsogolo, sagittal, coronal). CBCT yatsimikizira kuti ndi njira yodalirika komanso yolondola yodziwira ndi kuyerekezera kukula ndi kukula kwa zolakwika za mkati mwa fupa la nsagwada ndi kupotoza kochepa komanso kukulitsa pang'ono kusiyana ndi 2-D x-ray.

Chithunzi 2 Mawu: Kumanzere kumawonetsedwa ma radiograph a 2-D a nsagwada omwe amatengedwa kuchokera ku mikwingwirima yomwe imawonekera.

wathanzi. Kumanja kwa chithunzicho ndi zithunzi za nsagwada zomwezo zomwe zikuwonetsa zowoneka bwino za necrotic cavitation.

Chithunzi chosinthidwa kuchokera ku Bouquot, 2014.

Kafukufuku wachipatala awonetsa zithunzi za CBCT zimathandizanso kudziwa zomwe zili m'chiphuphu (chodzaza madzi, granulomatous, cholimba, ndi zina zotero), zomwe zimathandiza kusiyanitsa pakati pa zotupa zotupa, zotupa za odontogenic kapena non-odontogenic, cysts, ndi zina zoipa kapena zoipa. zotupa .

Mapulogalamu opangidwa posachedwapa omwe amaphatikizidwa makamaka ndi mitundu yosiyanasiyana ya zipangizo za CBCT amagwiritsa ntchito mayunitsi a Hounsfield (HU) omwe amalola kuwunika kovomerezeka kwa mafupa. HU imayimira kachulukidwe kakang'ono ka minofu ya thupi molingana ndi sikelo ya imvi, yotengera mpweya (-1000 HU), madzi (0 HU), ndi kachulukidwe ka mafupa (+1000 HU). Chithunzi 3 chikuwonetsa malingaliro osiyanasiyana a chithunzi chamakono cha CBCT.

Mwachidule, CBCT yatsimikizira kuti ndi yothandiza pakuzindikira ndi kuchiza ma cavitations a nsagwada ndi:

1. Kuzindikira kukula, kukula ndi malo a 3-D a chotupa;
2. Kuzindikiritsa kuyandikira kwa chotupa kuzinthu zina zapafupi za thupi monga

minyewa yotsika ya alveolar, maxillary sinus, kapena mizu yoyandikana ya dzino;

1. Kuzindikira njira yochiritsira: opaleshoni motsutsana ndi osachita opaleshoni; ndi
2. Kupereka chithunzi chotsatira kuti mudziwe kuchuluka kwa machiritso ndi kufunikira kotheka

kuchizanso chotupa.

Chithunzi 3 Kumveka bwino kwa chithunzi cha CBCT chifukwa cha teknoloji yoyengedwa ya mapulogalamu, yomwe imachepetsa zinthu zakale ndi "phokoso" zomwe zimayikidwa m'mano ndi kubwezeretsa zitsulo kungayambitse chithunzicho. Izi zimathandiza dokotala wa mano ndi wodwalayo kuti azitha kuona zilondazo mosavuta. Pamwambapa ndi mawonekedwe apanoramic a CBCT yowonetsa kumanzere (#17) ndi kumanja (#32) malo ndi kukula kwa zotupa za cavitational mu nsagwada osteonecrosis wodwala. Pansi kumanzere pali mawonekedwe a sagital a tsamba lililonse. Pansi kumanja ndi mawonekedwe a 3-D a malo #17 akuwonetsa cortical porosity overlying medullary cavitation. Mwachilolezo cha Dr. Reese.

ultrasound

Tikutchulanso mwachidule apa chipangizo cha ultrasound, CaviTAU™®, chomwe chapangidwa ndipo chikugwiritsidwa ntchito kumadera ena a ku Ulaya, makamaka kuti azindikire madera otsika kwambiri a nsagwada kumtunda ndi kumunsi kwa nsagwada zomwe zimasonyeza kuti pali ma cavitations a nsagwada. Chida ichi chotchedwa trans-alveolar ultrasonic sonography (TAU-n) chimakhala chofanana poyerekeza ndi CBCT pozindikira zolakwika za m'fupa la nsagwada, ndipo chimakhala ndi phindu lowonjezera powonetsa wodwalayo ku ma radiation otsika kwambiri. Chipangizochi sichikupezeka pano ku US koma chikuwunikiridwa ndi US Food and Drug Administration ndipo chikhoza kukhala chida chachikulu chodziwira matenda chomwe chimagwiritsidwa ntchito ku North America pochiza CIMJD.

Biomarkers ndi Histological Examination

Chifukwa cha kutupa kwa nsagwada cavitations Lechner ndi Baehr, 2017 afufuza kugwirizana zotheka pakati osankhidwa cytokines ndi matenda. Cytokine imodzi yochititsa chidwi kwambiri ndi 'yolamulidwa ikatsegulidwa, T-cell yodziwika bwino imawonetsedwa ndi kutulutsidwa' (RANTES). Cytokine iyi, komanso fibroblast growth factor (FGF) -2, imasonyezedwa mochuluka kwambiri mu zilonda za cavitational komanso odwala omwe ali ndi CIMDJ. Chithunzi cha 4, choperekedwa ndi Dr. Lechner, chikufanizira milingo ya RANTES kwa odwala omwe ali ndi cavitations (ofiira ofiira, kumanzere) ndi miyeso yaulamuliro wathanzi (buluu la buluu), kusonyeza miyeso yomwe imakhala yochuluka kuposa nthawi ya 25 mwa omwe ali ndi matendawa. Lechner et al amagwiritsa ntchito njira ziwiri zoyezera milingo ya cytokine. Chimodzi ndicho kuyeza milingo ya ma cytokines mwadongosolo kuchokera m'magazi (Diagnostic Solutions Laboratory, US.). Njira yachiwiri ndiyo kutenga biopsy molunjika kuchokera ku malo omwe ali ndi matenda pamene ikupezeka kuti iwunikidwe ndi oral pathologist. Tsoka ilo, panthawiyi sampuli zamtundu wamtunduwu zimafuna kukonza zovuta ndi kutumiza zomwe siziyenera kukwaniritsidwa m'malo osachita kafukufuku, koma zapereka malumikizanidwe ozindikira.

Chithunzi 4 Kugawidwa kwa RANTES mumilandu 31 ya FDOJ ndi zitsanzo 19 za nsagwada wamba poyerekeza ndi kachulukidwe ka x-ray kwa magulu onse awiri m'malo ofananira. Machaputala: RANTES, yoyendetsedwa poyambitsa, T-cell yodziwika bwino yowonetsedwa ndi kutulutsidwa kwa chemokine (CC motif) ligand 5; XrDn, kachulukidwe ka X-ray; FDOJ, mafuta osachiritsika osteonecrosis a nsagwada; n, nambala; Ctrl, control. Chithunzi choperekedwa ndi Dr. Lechner. Nambala yachilolezo: CC BY-NC 3.0

Zolinga Zosintha Zolinga Zowunika

Kukhalapo kwa nsagwada cavitations kwakhazikitsidwa bwino kuchipatala. Komabe, matenda omveka bwino komanso njira zabwino zothandizira odwala zimafunikira kufufuza kwina. Poganizira izi m'pofunika kutchula mwachidule njira zingapo zochititsa chidwi komanso zomwe zingakhale zamtengo wapatali zomwe zimagwiritsidwa ntchito ndi akatswiri ena.

Zithunzi

Zimazindikirika kuti kuwunika kowonjezera kwa physiologic kungakhale chida chofunikira chowunikira komanso chowunikira. Chida chimodzi chotere chomwe amagwiritsidwa ntchito ndi akatswiri ena ndi kujambula kwa thermographic. Ntchito yotupa yokhazikika imatha kuwoneka poyesa kusiyana kwa kutentha pamwamba pamutu ndi khosi. Thermography ndi yotetezeka, yofulumira ndipo ikhoza kukhala ndi chidziwitso chofanana ndi cha CBCT. Choyipa chachikulu ndichakuti alibe tanthauzo, zomwe zimapangitsa kuti zikhale zovuta kuzindikira mbali kapena kukula kwa chotupa.

Acupuncture Meridian Assessment

Madokotala ena akuyang'ana mbiri yamphamvu ya zilonda zogwiritsa ntchito Acupuncture Meridian Assessment (AMA) kuti adziwe momwe zimakhudzira mphamvu yake yofananira. Kuwunika kwamtunduwu kumakhazikitsidwa mu Electroacupuncture Malinga ndi Voll (EAV) . Njira imeneyi, yozikidwa pa mankhwala akale achi China ndi mfundo za acupuncture, yapangidwa ndipo ikuphunzitsidwa ku US. Acupuncture amagwiritsidwa ntchito pochepetsa ululu komanso kulimbikitsa machiritso. Zimatengera kuchuluka kwa mphamvu (ie, Chi) kudzera munjira zenizeni zamphamvu m'thupi. Njirazi, kapena meridians, zimagwirizanitsa ziwalo, minofu, minofu ndi mafupa wina ndi mzake. Acupuncture amagwiritsa ntchito mfundo zenizeni kwambiri pa meridian kuti akhudze thanzi ndi mphamvu zazinthu zonse za thupi pa meridianyo. Njira imeneyi yakhala ikugwiritsidwa ntchito poulula matenda a nsagwada, kuti akathetsedwa, amachitiranso matenda ooneka ngati osagwirizana, monga nyamakazi kapena matenda otopa kwambiri . Njirayi imathandizira kufufuza kwina (mwachitsanzo, zotsatira ziyenera kulembedwa ndi kupezedwa ndi kufalitsa deta yotalikirapo).

ZOKHUDZA

Pali zinthu zambiri zomwe zimawonjezera chiopsezo cha chitukuko cha nsagwada cavitations koma nthawi zambiri chiopsezo chimakhala chochuluka. Zowopsa kwa munthu zimatha kukhala zisonkhezero zakunja, monga zachilengedwe kapena zamkati, monga kusagwira bwino ntchito kwa chitetezo chamthupi. Matebulo 2 ndi 3 amatchula zinthu zoopsa zakunja ndi zamkati.

Dziwani kuti Table 2, Internal Risk Factors, sichiphatikizapo chibadwa. Ngakhale kusiyana kwa majini kungaganizidwe kuti kumagwira ntchito, palibe kusintha kwa jini kapena kuphatikiza kwa majini komwe kwasonyezedwa kuti ndi koopsa, komabe zisonkhezero za majini ndizotheka. . Kuwunika mwadongosolo kwamabuku komwe kunachitika mu 2019 kunawonetsa kuti ma nucleotide polymorphisms angapo adadziwika, koma palibe kubwerezanso pamaphunziro onse. Olembawo adatsimikiza kuti chifukwa cha kusiyanasiyana kwa majini omwe awonetsa mayanjano abwino ndi ma cavitations komanso kusowa kwa kuberekanso kwa maphunziro, gawo lomwe limakhudzidwa ndi zomwe zimayambitsa ma genetic zitha kuwoneka ngati zocheperako komanso zosawerengeka. Komabe, kuyang'ana anthu enieni kungakhale kofunikira kuti muzindikire kusiyana kwa majini . Zowonadi, monga momwe zasonyezedwera, imodzi mwa njira zodziwika bwino komanso zoyambira zapathophysiologic za kuwonongeka kwa fupa la ischemic ndi kutsekeka kochulukirapo kuchokera kumayiko a hypercoagulation, omwe nthawi zambiri amakhala ndi ma genetic underpinnings, monga akufotokozera Bouquot and Lamarche (1999) . Table 4 yoperekedwa ndi Dr. Bouquot, imatchula za matendawa zomwe zimaphatikizapo hypercoagulation ndi ndime zotsatirazi za 3 zimapereka chithunzithunzi cha zomwe Dr.

Mu nsagwada cavitations pali umboni woonekeratu wa ischemic osteonecrosis, amene ndi m`mafupa matenda kumene fupa amakhala necrotic chifukwa cha mpweya ndi kusowa kwa michere. Monga tanenera, zinthu zambiri zingagwirizane kuti zipangitse ma cavitations ndipo mpaka 80% ya odwala ali ndi vuto, lomwe nthawi zambiri limakhala lobadwa nalo, la kupanga kwambiri magazi m'mitsempha yawo. Matendawa nthawi zambiri samawonekera poyezetsa magazi nthawi zonse. Bone makamaka atengeke vuto la hypercoagulation ndi akukula kwambiri dilated mitsempha ya magazi; kuchuluka, nthawi zambiri zowawa, kupsyinjika kwamkati; kusayenda kwa magazi; komanso ngakhale infarction. Vuto la hypercoagulation likhoza kufotokozedwa ndi mbiri ya banja la sitiroko ndi matenda a mtima ali aang'ono (osakwana zaka 55), kubwezeretsa m'chiuno kapena "nyamakazi" (makamaka ali aang'ono), osteonecrosis (makamaka ali aang'ono), kuya. thrombosis ya mtsempha, pulmonary emboli (kuundana kwa magazi m'mapapo), retina vein thrombosis (kutsekeka kwa retina m'diso) ndi kupita padera kobwerezabwereza. Nsagwada zimakhala ndi zovuta ziwiri za matendawa: 2) ikawonongeka, fupa lodwala silingathe kupirira matenda otsika kwambiri kuchokera ku mabakiteriya a dzino ndi chingamu; ndi 1) fupa silingathe kuchira chifukwa cha kuchepa kwa magazi chifukwa cha mankhwala oletsa ululu omwe amagwiritsidwa ntchito ndi madokotala a mano panthawi ya ntchito ya mano. Chithunzi 2 chimapereka chithunzithunzi cha microscopic cha intravascular thrombus.

Gulu 4 Matendawa amatchedwa hypercoagulation. Odwala anayi mwa asanu mwa odwala nsagwada cavitation ali ndi chimodzi mwa izi

zinthu zovuta.

Mosasamala kanthu za chomwe chimayambitsa hypercoagulation, fupa limapanga kapena kukhala ndi fibrous marrow (ulusi ukhoza kukhala m'madera osowa zakudya), mafuta ochuluka, akufa ("kuwola konyowa"), fupa louma kwambiri, nthawi zina lachikopa ("kuwola kowuma" ), kapena malo opanda dzenje ("cavitation").

Fupa lirilonse likhoza kukhudzidwa, koma chiuno, mawondo ndi nsagwada nthawi zambiri zimakhudzidwa. Ululu nthawi zambiri umakhala waukulu koma pafupifupi 1/3^rd odwala samamva ululu. Thupi limavutika kudzichiritsa lokha ku matendawa komanso 2/3^rds milandu amafuna kuchotsa opareshoni m`mafupa owonongeka, nthawi zambiri ndi kukanda ndi curettes. Opaleshoni idzathetsa vutoli (ndi ululu) pafupifupi 3/4^izi Odwala omwe ali ndi vuto la nsagwada, ngakhale maopaleshoni obwerezabwereza, omwe nthawi zambiri amakhala ang'onoang'ono kuposa oyamba, amafunikira 40% ya odwala, nthawi zina m'malo ena a nsagwada, chifukwa matendawa nthawi zambiri amakhala ndi zotupa za "dumpha" (mwachitsanzo, malo angapo mu nsagwada). mafupa ofanana kapena ofanana), ndi m'mafupa wabwinobwino pakati. Oposa theka la odwala m'chiuno pamapeto pake adzalandira matendawa m'chiuno chosiyana. Zoposa 1/3^rd odwala nsagwada adzalandira matenda ena quadrants nsagwada. Posachedwapa, zapezeka kuti 40% ya odwala osteonecrosis a m'chiuno kapena nsagwada amayankha anticoagulation ndi otsika molecular kulemera heparin (Lovenox) kapena Coumadin ndi kuthetsa ululu ndi ndi mafupa machiritso.

Chithunzi 5 Mawonekedwe a microscopic a intravascular thrombi

Ngati kufunafuna njira yopanda mankhwala yochepetsera chiopsezo cha hypercoagulation munthu angaganizire kugwiritsa ntchito ma enzymes owonjezera monga nattokinase kapena lumbrokinase yamphamvu kwambiri onse omwe ali ndi fibrinolytic ndi anticoagulation properties. Komanso, mkuwa akusowa limati, amene kugwirizana ndi coagulation kukanika, ayenera kuchotsedwa chifukwa cha chiopsezo hypercoagulation anati odwala ndi nsagwada cavitations.

ZOKHUDZA ZINTHU ZOTHANDIZA NDI ZA chipatala

Kukhalapo kwa ma cavitations a nsagwada ndi matenda omwe amalumikizana nawo kumaphatikizanso zizindikiro zina koma nthawi zambiri kumaphatikizanso zizindikiro zina zosadziwika bwino. Choncho, matenda ake ndi chithandizo chake chiyenera kuganiziridwa mozama ndi gulu losamalira. Kuzindikira kwapadera kwambiri komanso kosasunthika komwe kwadziwika kuyambira pepala la IAOMT 2014 ndikuthana ndi zovuta zowoneka ngati zosakhudzana ndi kutupa pambuyo pa chithandizo cha cavitation. Kaya matenda a systemic ndi amtundu wa autoimmune kapena kutupa komwe kumachitika mwanjira ina, kusintha kwakukulu kwanenedwa, kuphatikiza kusintha kwa khansa. Zizindikiro zovuta zomwe zimagwirizanitsidwa ndi zilondazi zimakhala zapayekha ndipo motero sizodziwika kapena kudziwika mosavuta. Choncho, IAOMT ndi maganizo akuti pamene wodwala apezeka ndi nsagwada cavitations ndi kapena popanda kugwirizana ndi ululu m'deralo, komanso ali ndi matenda ena dongosolo m'mbuyomu sanali chifukwa cha nsagwada cavitations, wodwalayo ayenera kuwunika mowonjezereka kuti adziwe ngati matenda akugwirizana ndi , kapena ndi chotsatira cha matendawa. IAOMT inafufuza mamembala ake kuti aphunzire zambiri za zomwe zizindikiro / matenda amathetsa pambuyo pa opaleshoni ya cavitational. Zotsatira zaperekedwa mu Zowonjezera I.

Kukhalapo kwa ma cytokines omwe amapangidwa m'mitsempha yopanda mitsempha, zotupa za necrotic za cavitations za nsagwada zikuwoneka kuti zimagwira ntchito ngati ma cytokines otupa omwe amasunga madera ena otupa komanso / kapena osatha. Kupumula kapena kusintha pang'ono kuchokera ku ululu wa nsagwada pambuyo pa chithandizo kumayembekezeredwa ndikuyembekezeredwa, koma chiphunzitso chokhazikika cha kutupa, chomwe tikambirana mwatsatanetsatane pansipa, chikhoza kufotokoza chifukwa chake matenda ambiri omwe amawoneka ngati 'osagwirizana' omwe amalumikizana ndi kutupa kosatha. amachepetsedwanso ndi chithandizo cha cavitation.

Pogwirizana ndi zomwe zinalembedwa mu pepala la IAOMT la 2014 lomwe limagwirizanitsa ma cavitations a nsagwada ndi matenda amtundu uliwonse, kafukufuku ndi maphunziro azachipatala omwe asindikizidwa posachedwapa ndi Lechner, von Baehr ndi ena, amasonyeza kuti zilonda za jawbone cavitation zili ndi mbiri ya cytokine yomwe sinawoneke m'mafupa ena a mafupa. . Poyerekeza ndi zitsanzo za nsagwada zathanzi, cavitation pathologies nthawi zonse imasonyeza kuwonjezereka kwamphamvu kwa fibroblast growth factor (FGF-2), Interleukin 1 receptor antagonist (Il-1ra), ndipo, makamaka, RANTES. RANTES, yomwe imadziwikanso kuti CCL5 (cc motif Ligand 5) yafotokozedwa ngati chemotactic cytokine yokhala ndi mphamvu yotupa yotupa. Ma chemokines awa awonetsedwa kuti amasokoneza magawo angapo a chitetezo chamthupi ndipo amakhudzidwa kwambiri ndi matenda ndi matenda osiyanasiyana. Kafukufuku wasonyeza kuti RANTES imakhudzidwa ndi matenda ambiri amtundu uliwonse monga nyamakazi, matenda otopa kwambiri, atopic dermatitis, nephritis, colitis, alopecia, matenda a chithokomiro komanso kupititsa patsogolo multiple sclerosis ndi Parkinson. Kupitilira apo, RANTES yawonetsedwa kuti imayambitsa kukula kwa chotupa.

Zinthu za kukula kwa Fibroblast zakhudzidwanso ndi ma cavitations a nsagwada. Zinthu zokulirapo za Fibroblast, FGF-2, ndi ma receptor omwe amalumikizana nawo, ali ndi udindo pa ntchito zambiri zofunika, kuphatikiza kuchuluka kwa maselo, kupulumuka, ndi kusamuka. Amakhalanso pachiwopsezo chobedwa ndi ma cell a khansa ndikuchita nawo gawo la oncogenic m'makhansa ambiri. Mwachitsanzo, FGF-2 imalimbikitsa kukula kwa chotupa ndi khansa mu khansa ya prostate. Kuphatikiza apo, milingo ya FGF-2 yawonetsa kulumikizana kwachindunji ndi kupitilira, metastasis komanso kupulumuka koyipa kwa odwala khansa yapakhungu. Poyerekeza ndi zowongolera zopanda khansa, odwala omwe ali ndi gastric carcinoma amakhala ndi milingo yayikulu kwambiri ya FGF-2 mu seramu yawo. Amithenga otupawa akhala akukhudzidwa ndi matenda ambiri oopsa ngakhale ali otupa kapena khansa. Mosiyana ndi RANTES/CCL5 ndi FGF-2, IL1-ra yasonyezedwa kuti imakhala ngati mkhalapakati wamphamvu wotsutsa-kutupa, zomwe zimapangitsa kuti pakhale kusowa kwa zizindikiro zodziwika bwino mkati mwa zilonda zina za cavitation.

Magulu ochulukirapo a RANTES ndi FGF-2 mu zotupa za cavitation afananizidwa ndikulumikizidwa ndi milingo yomwe imawonedwa m'matenda ena amthupi monga amyotrophic lateral sclerosis, (ALS) multiple sclerosis (MS), nyamakazi ya nyamakazi ndi khansa ya m'mawere. Zowonadi, milingo ya amithengawa opezeka mu nsagwada cavitations ndi apamwamba kuposa mu seramu ndi cerebrospinal madzimadzi a ALS ndi MS odwala. Kafukufuku waposachedwa ndi Lechner ndi von Baehr wawonetsa kuwonjezeka kwa 26 kwa RANTES mu nsagwada za osteonecrotic zotupa za odwala khansa ya m'mawere. Lechner ndi ogwira nawo ntchito akuwonetsa kuti cavitation yochokera ku RANTES itha kukhala chothandizira pakukula ndi kukula kwa khansa ya m'mawere.

Monga tanena kale, pali milandu yambiri ya asymptomatic nsagwada cavitations. Pazifukwa izi, ma cytokines oyambitsa kutupa kwambiri monga TNF-alpha ndi IL-6, SAKUWONA m'ziwerengero zowonjezeka muzofukufuku za pathohistological of cavitation samples. Odwalawa, kusakhalapo kwa ma cytokines oyambitsa kutupa kumagwirizana ndi kuchuluka kwa anti-inflammatory cytokine Interleukin 1-receptor antagonist (Il-1ra). Chowonadi ndi chakuti kutupa kwakukulu komwe kumayenderana ndi ma cavitations a nsagwada kumayendetsedwa ndi kuchuluka kwa RANTES/FGF-2. Chotsatira chake, kuti adziwe matenda, Lechner ndi von Baehr akusonyeza kuti akugogomezera za kukhalapo kwa kutupa ndi kulingalira njira yowonetsera, makamaka kudzera pa RANTES/FGF-2. Magulu akuluakulu a RANTES/FGF-2 mu odwala cavitation akuwonetsa kuti zotupazi zitha kuyambitsa njira zofananira komanso kulimbikitsana njira zolumikizira ziwalo zina. Chitetezo cha mthupi chimayankhidwa poyankha zizindikiro zoopsa, zomwe zimabweretsa njira zosiyanasiyana zobadwa nazo zomwe zimafika pachimake pakupanga ma cytokine komanso kuthekera koyambitsa chitetezo chamthupi. Izi zimagwirizana ndi lingaliro ndi chiphunzitso, kuti mafupa a nsagwada amatha kukhala chifukwa chachikulu cha matenda otupa osachiritsika kudzera pakupanga kwa RANTES/FGF-2 ndikufotokozeranso chifukwa chake zizindikiro zazikulu za kutupa sizimawonedwa nthawi zonse kapena kumva ndi wodwala zotupa za nsagwada. okha. Chifukwa chake, ma cavitations a nsagwada ndi amithenga okhudzidwawa amayimira gawo lophatikizana la matenda otupa ndipo amakhala ngati etiology ya matendawa. Kuchotsa ma cavitations kungakhale chinsinsi chobwezeretsa matenda otupa. Izi zimathandizidwa ndikuwona kuchepa kwa seramu RANTES pambuyo pochita opaleshoni odwala khansa ya m'mawere 5 (Onani Table 5). Kufufuza kwina ndi kuyesa milingo ya RANTES/CCL5 kungapereke chidziwitso pa ubalewu. Zomwe zimalimbikitsa ndikusintha kwa moyo wabwino ndi odwala ambiri a jawbone cavitation, kaya ndi mpumulo pamalo ogwirira ntchito kapena kuchepa kwa kutupa kosatha kapena matenda kwina.

Gulu 5

Kuchepetsa (Kufiira) mu RANTES/CCL5 mu seramu mu 5 odwala khansa ya m'mawere omwe anachitidwa opaleshoni ya mafuta odegenerative osteonecrosis a nsagwada (FDOJ). Table adasinthidwa kuchokera

Lechner et al, 2021. Jawbone Cavitation Yofotokozedwa RANTES/CCL5: Nkhani Zogwirizanitsa Kutupa Kwachete M’nsagwada ndi Epistemology ya Khansa ya M’mawere.” Khansa ya M'mawere: Zolinga ndi Chithandizo.

Njira Zochiritsira

Chifukwa cha kuchepa kwa mabuku okhudzana ndi chithandizo cha zilonda zam'mimba, IAOMT idafufuza mamembala ake kuti asonkhanitse zambiri zokhudzana ndi zomwe zikuchitika komanso machiritso omwe akukula kuti akhale 'mulingo wa chisamaliro'. Zotsatira za kafukufukuyu zikukambidwa mwachidule mu Zowonjezera II.

Pamene malo ndi kukula kwa zilondazo zatsimikiziridwa, njira zochiritsira zimafunika. IAOMT ndi ya malingaliro omwe nthawi zambiri sizovomerezeka kusiya "fupa lakufa" m'thupi la munthu. Izi zimachokera ku zomwe zikusonyeza kuti ma cavitations a nsagwada amatha kukhala maziko a systemic cytokines ndi endotoxins kuti ayambe kuwononga thanzi la wodwala.

Pazifukwa zabwino, biopsy iyenera kuchitidwa kuti itsimikizire matenda a nsagwada zamtundu uliwonse ndikuchotsa matenda ena. Kenako, chithandizo chochotsa kapena kuthetsa matenda okhudzidwawo ndikulimbikitsa kukulanso kwa fupa lofunika kwambiri. Pa nthawiyi m'mabuku owunikiridwa ndi anzawo, chithandizo cha opaleshoni chomwe chimaphatikizapo kuchotsa fupa losafunikira kwambiri lomwe lakhudzidwa likuwoneka ngati njira yabwino yothandizira ma cavitations a nsagwada. Kuchiza kumaphatikizapo kugwiritsa ntchito mankhwala ogonetsa am'deralo, zomwe zimapangitsa kuti munthu aganizire mozama. Poyamba ankaganiza kuti epinephrine yomwe ili ndi mankhwala oletsa ululu, omwe amadziwika kuti vasoconstrictive katundu, ayenera kupewedwa kwa odwala omwe angakhale atasokoneza kale magazi okhudzana ndi matenda awo. Komabe, m'magulu a maphunziro a maselo, kusiyana kwa osteoblastic kunakula pogwiritsa ntchito epinephrine. Choncho, dokotala ayenera kudziwa pazochitika zilizonse kuti agwiritse ntchito epinephrine ndipo ngati ndi choncho, ndalama zomwe ziyenera kugwiritsidwa ntchito zomwe zidzapereke zotsatira zabwino kwambiri.

Pambuyo pokongoletsa maopaleshoni ndikuchira bwino kwa chotupacho ndikuthirira ndi saline wosabala bwino, kuchiritsa kumakulitsidwa ndi kuyika kwa mapulateleti olemera a fibrin (PRF) m'malo opanda osseous. Kugwiritsiridwa ntchito kwa mapulateleti olemera a fibrin kumangoganizira za opaleshoni sikungopindulitsa kokha kuchokera ku kutsekeka kwa magazi, komanso kuchokera ku gawo la kutulutsa zinthu za kukula kwa nthawi mpaka masiku khumi ndi anayi pambuyo pa opaleshoni. Asanayambe kugwiritsa ntchito PRF grafts ndi mankhwala ena owonjezera, kubwereranso kwa nsagwada ya osteonecrotic lesion pambuyo pa opaleshoni kunachitika pafupifupi 40% ya milandu.

Kuyang'ana paziwopsezo zakunja zomwe zafotokozedwa mu Gulu 2 zikuwonetsa mwamphamvu kuti zotsatira zoyipa zitha kupewedwa ndi njira yoyenera ya opaleshoni komanso kulumikizana ndi dokotala/odwala, makamaka m'magulu omwe ali pachiwopsezo. Ndikoyenera kulingalira kugwiritsa ntchito njira zodzidzimutsa, kuchepetsa kapena kupewa matenda a periodontal ndi matenda ena a mano, ndikusankha malo opangira zida zomwe zingalole kuchiritsa kwabwino kwambiri. Kupereka malangizo omveka bwino asanayambe komanso atatha opaleshoni kwa wodwalayo, kuphatikizapo kuopsa kokhudzana ndi kusuta fodya kungathandize kuchepetsa zotsatira zoipa.

Pokumbukira mndandanda waukulu wa zinthu zomwe zingayambitse chiopsezo zomwe zatchulidwa mu Table 2 ndi 3, kukambirana ndi gulu lothandizira odwala akulimbikitsidwa kuti adziwe bwino zomwe zingatheke zobisika zomwe zingayambitse chitukuko cha nsagwada. Mwachitsanzo, chofunika kwambiri pochiza ma cavitations a nsagwada ndikuti ngati munthuyo akumwa mankhwala osokoneza bongo, makamaka kusankha serotonin reuptake inhibitors (SSRIs). SSRIs akhala akugwirizana ndi kuchepa kwa mafupa a mafupa ndi kuwonjezeka kwa fractures. SSRI Fluoxetine (Prozac) imalepheretsa mwachindunji kusiyana kwa osteoblast ndi mineralization. Pafupifupi maphunziro awiri odziyimira pawokha omwe amawunika ogwiritsa ntchito a SSRI poyerekeza ndi zowongolera awonetsa kuti kugwiritsa ntchito kwa SRRI kumalumikizidwa ndi mawonekedwe oyipa kwambiri a panoramic morphometric.

Preconditioning ingathandizenso kuti chithandizo chikhale chopambana. Izi zimaphatikizapo kupanga malo opangira machiritso popatsa thupi milingo yokwanira yazakudya zomwe zimathandizira kuti chilengedwe chikhale bwino pokwaniritsa homeostasis m'thupi. Njira zowonetseratu sizili zotheka nthawi zonse, kapena zovomerezeka kwa wodwala, koma ndizofunikira kwambiri kwa odwala omwe adziwa zovuta, monga omwe ali ndi chibadwa, matenda a machiritso kapena thanzi labwino. Zikatero, ndikofunikira kuti kukhathamiritsa uku kuchitike kuti muchepetse kupsinjika kwa okosijeni, zomwe sizingangoyambitsa matenda koma zimatha kusokoneza machiritso omwe mukufuna.

Moyenera, kuchepetsa katundu wapoizoni m'thupi monga fluoride ndi/kapena mercury kuchokera kumano amalgam amalgam ayenera kutsirizidwa musanalandire chithandizo cha nsagwada cavitations. Mercury imatha kusuntha chitsulo mu unyolo wonyamula ma elekitironi wa mitochondria. Izi zimabweretsa chitsulo chaulere chochulukirapo (chitsulo chachitsulo kapena Fe ++), kutulutsa mitundu yowononga ya okosijeni (ROS) yomwe imadziwikanso kuti ma free radicals, omwe amayambitsa kupsinjika kwa okosijeni. Kuchuluka kwachitsulo m'mafupa kumalepheretsanso kugwira ntchito bwino kwa osteoblasts, zomwe mwachiwonekere zidzakhala ndi zotsatira zoipa poyesa kuchiritsa matenda a mafupa .

Zofooka zina ziyeneranso kuthandizidwa musanalandire chithandizo. Pamene pali akusowa bioavailable mkuwa, magnesium ndi retinol, kagayidwe ndi yobwezeretsanso chitsulo amakhala dysregulated mu thupi, zomwe zimathandiza kuti owonjezera ufulu chitsulo m`malo olakwika kutsogolera ngakhale kwambiri oxidative nkhawa ndi chiopsezo cha matenda. Mwachindunji, michere yambiri m'thupi (monga ceruloplasmin) imakhala yosagwira ntchito ngati palibe milingo yokwanira yamkuwa, magnesiamu, ndi retinol, zomwe zimakulitsa kusokonezeka kwachitsulo ndikuwonjezera kupsinjika kwa okosijeni ndi chiopsezo cha matenda.

Njira Zina Zochiritsira

Njira zina zomwe zimagwiritsidwa ntchito ngati chithandizo choyambirira kapena chothandizira ziyenera kuyesedwanso. Izi zikuphatikizapo homeopathy, kukondoweza magetsi, chithandizo chopepuka monga photobiomodulation, ndi laser, kalasi yachipatala oxygen / ozoni, hyperbaric oxygen, anticoagulation modalities, Sanum mankhwala, zakudya ndi nutraceuticals, infra-red sauna, mtsempha wa ozoni mankhwala, mankhwala mphamvu, ndi zina. Pakadali pano, sayansi sinachitike yomwe ingatsimikizire mitundu ina yamankhwala kuti ikhale yotheka kapena yosagwira ntchito. Miyezo ya chisamaliro kuti muwonetsetse kuti machiritso oyenera ndi kuchotsa poizoni ayenera kukhazikitsidwa. Njira zowunikira kupambana ziyenera kuyesedwa ndikukhazikika. Ndondomeko kapena njira zothandizira kudziwa ngati chithandizo chili choyenera komanso ngati sichiyenera kuperekedwa kuti chiwunikenso.

MAFUNSO

Kafukufuku wasonyeza kuti kukhalapo kwa nsagwada cavitations ndi mochenjera matenda ndondomeko kugwirizana ndi kuchepa magazi. Kuwonongeka kwa magazi a medullary kumabweretsa kuchepa kwa mineralized komanso kusakwanira kwa mitsempha m'malo a nsagwada omwe amatha kutenga tizilombo toyambitsa matenda, kukulitsa kufa kwa ma cell. Kuthamanga kwa magazi kwaulesi mkati mwa zotupa za cavitational kumatsutsa kuperekedwa kwa maantibayotiki, zakudya zopatsa thanzi komanso ma antibodies. Malo a ischemic amathanso kukhala ndi kulimbikitsa oyimira pakati otupa omwe amatha kukhala ndi zotsatira zoyipa kwambiri paumoyo wadongosolo. Kutengera chibadwa, kuchepa kwa chitetezo cha mthupi, zotsatira za mankhwala ena, kuvulala ndi matenda, ndi zinthu zina monga kusuta kungayambitse kapena kufulumizitsa kukula kwa nsagwada.

Pamodzi ndi katswiri wodziwika bwino wa nsagwada, Dr. Jerry Bouquot, IAOMT ikupereka ndikulimbikitsa kuzindikiritsa kolondola kwa nsagwada za nsagwada monga Chronic Ischemic Medullary Disease of the Jawbone, CIMDJ. Ngakhale kuti mayina ambiri, acronyms, ndi mawu ali ndi mbiri yakale ndipo pakali pano akugwiritsidwa ntchito kutanthauza matendawa, IAOMT ikukhulupirira kuti ili ndilo liwu loyenera kwambiri lofotokozera za matenda a pathologic ndi micro-histologic zomwe zimapezeka kawirikawiri mu cavitations za jawbone.

Ngakhale kuti zilonda za nsagwada za cavitational zimakhala zovuta kuzizindikira ndi ma radiographs nthawi zonse ndipo zambiri sizipweteka, munthu sayenera kuganiza kuti matendawa kulibe. Pali njira zambiri za matenda zomwe zimakhala zovuta kuzizindikira, komanso zambiri zomwe sizipweteka. Ngati titagwiritsa ntchito ululu monga chizindikiro cha chithandizo, matenda a periodontal, shuga ndi khansa zambiri sizingachiritsidwe. Today mano dokotala ali sipekitiramu yotakata ya modalities bwinobwino kuchiza nsagwada cavitations ndi kulephera kuvomereza matenda ndi amalangiza mankhwala si zochepa kwambiri kuposa kulephera matenda ndi kuchiza periodontal matenda. Kwa thanzi ndi moyo wa odwala athu, kusintha kwachidziwitso ndikofunikira kwa onse ogwira ntchito zachipatala, kuphatikizapo madokotala a mano ndi zachipatala, kuti 1) azindikire kuchuluka kwa nsagwada cavitations ndi 2) kuvomereza kugwirizana pakati pa nsagwada cavitations ndi matenda systemic.

ZA KUMAPETO I

IAOMT SURVEY 2 RESULTS (2023)

Monga tafotokozera mwachidule mu pepalali, zinthu zosagwirizana nthawi zambiri zimachotsa pambuyo pa opaleshoni ya cavitation. Kuti mudziwe zambiri za momwe mikhalidwe imathetsedwera komanso momwe kukhululukidwa kwafupipafupi kumachitika pokhudzana ndi opaleshoni, kafukufuku wachiwiri adatumizidwa kwa umembala wa IAOMT. Mndandanda wa zizindikiro ndi mikhalidwe yomwe mamembala a komitiyi awona kuti akusintha pambuyo pa opaleshoni adalembedwa kuti afufuze. Ofunsidwa adafunsidwa ngati adawonapo chilichonse mwazinthu izi zomwe zimachotsedwa pambuyo pa opaleshoni, ndipo ngati zinali choncho mpaka pamlingo wotani. Adafunsidwanso ngati zizindikirozo zidachotsedwa mwachangu kapena ngati kusinthako kudatenga nthawi yayitali kuposa miyezi iwiri. Kuphatikiza apo, omwe adafunsidwa adafunsidwa ngati amachita opaleshoni pamalo amodzi, malo angapo osagwirizana, kapena malo onse pa opaleshoni imodzi. Zotsatira za kafukufukuyu zikuwonetsedwa muzithunzi pansipa. Detayi ndi yoyambirira, chifukwa chiwerengero cha omwe adafunsidwa chinali chochepa (33) komanso kuti pali zina zomwe zikusowa.

Appx I Chithunzi 1 Ofunsidwa adavotera kuchuluka kwa kusintha (kochepa, kocheperako kapena kofunikira) ndipo adawona ngati kusintha kudachitika mwachangu (miyezi 0-2) kapena kudatenga nthawi yayitali (> miyezi iwiri). Mikhalidwe/zizindikiro zalembedwa motsatira zomwe zanenedwa zambiri. Dziwani kuti mikhalidwe/zizindikiro zambiri zachotsedwa pasanathe miyezi iwiri (kumanzere kwa mzere wapakati).

Appx I Chithunzi 2 Monga tawonetsera pamwambapa, nthawi zambiri, Ofunsidwa sanazindikire nthawi yobwezeretsa kuti apite patsogolo.

Appx I Chithunzi 3 Oyankha adayankha funsoli, "Kodi mumalimbikitsa/mumachita

Opaleshoni ya malo amodzi, malo ochitira limodzi, kapena malo onse ochitidwa opaleshoni imodzi?"

ZOKHUDZA II

IAOMT SURVEY 1 RESULTS (2021)

Chifukwa cha kuchepa kwa zolemba komanso ndemanga zachipatala zokhudzana ndi chithandizo cha zilonda za cavitational, IAOMT inafufuza mamembala ake kuti apeze zambiri zokhudzana ndi zomwe zikuchitika ndi mankhwala omwe akukula kuti akhale 'muyezo wa chisamaliro'. Kafukufuku wathunthu akupezeka patsamba la IAOMT (zindikirani kuti si onse omwe adayankha mafunso onse ofufuza).

Kufotokozera mwachidule, ambiri mwa anthu 79 omwe amafunsidwa amapereka chithandizo cha opaleshoni, chomwe chimaphatikizapo kuwonetsetsa kwa minofu yofewa, kupeza opaleshoni ya malo a cavitation, ndi njira zosiyanasiyana zoyeretsera thupi ndi kupha tizilombo toyambitsa matenda. Mankhwala osiyanasiyana, zakudya zopatsa thanzi, ndi / kapena zinthu zamagazi zimagwiritsidwa ntchito kulimbikitsa machiritso a zilondazo asanatseke kudulidwa kwa minofu yofewa.

Ma rotary burs nthawi zambiri amagwiritsidwa ntchito kutsegula kapena kupeza zilonda zam'mafupa. Madokotala ambiri amagwiritsa ntchito chida chamanja pochiza kapena kukwapula fupa lomwe ladwala (68%), koma njira zina ndi zida zimagwiritsidwanso ntchito, monga rotary bur (40%), piezoelectric (ultrasonic) chida (35%) kapena ER: YAG laser (36%), yomwe ndi ma frequency a laser omwe amagwiritsidwa ntchito pojambula zithunzi.

Malowa akayeretsedwa, kuchotsedwa, ndi/kapena kuchiritsidwa, ambiri omwe amafunsidwa amagwiritsa ntchito madzi/gasi wa ozoni kuti aphe tizilombo ndi kulimbikitsa machiritso. 86% ya omwe anafunsidwa amagwiritsa ntchito PRF (platelet-rich fibrin), PRP (plasma-rich plasma) kapena ozonated PRF kapena PRP. Njira yodalirika yophera tizilombo yomwe yafotokozedwa m'mabuku komanso mkati mwa kafukufukuyu (42%) ndikugwiritsira ntchito Er:YAG. 32% mwa omwe adafunsidwa sagwiritsa ntchito mtundu uliwonse wa mafupa kuti akwaniritse malo a cavitation.

Ambiri omwe adafunsidwa (59%) nthawi zambiri samawona zotupa zomwe zimatchula zifukwa zosiyanasiyana kuchokera ku mtengo wake, kulephera kupeza zitsanzo za minofu yotheka, kuvutika kupeza labu ya matenda, kapena kutsimikizika kwa momwe matendawa alili.

Ambiri omwe adafunsidwa sagwiritsa ntchito mankhwala opha maantibayotiki asanayambe opaleshoni (79%), panthawi ya opaleshoni (95%) kapena pambuyo popanga opaleshoni (69%). Thandizo lina la IV lomwe limagwiritsidwa ntchito likuphatikizapo dexamethasone steroids (8%) ndi Mavitamini C (48%). Ambiri omwe adafunsidwa (52%) amagwiritsa ntchito positi ya laser therapy (LLLT) pochiza. Ambiri omwe adafunsidwa amalimbikitsa chithandizo cha michere kuphatikiza mavitamini, mchere, ndi ma homeopathic osiyanasiyana (81%) asanafike (93%) komanso nthawi (XNUMX%) ya machiritso.

ZOKHUDZA III

Images

Chithunzi cha Appx III Gulu lakumanzere: 2D X-ray diagnostics of area #38. Gulu lakumanja: Zolemba za mlengalenga wa FDO) m'dera la retromolar 38/39 pogwiritsa ntchito chosiyanitsa pambuyo pa opaleshoni ya FDOJ.

Machaputala: FDOJ, fatty degenerative osteonecrosis ya nsagwada.

Adasinthidwa kuchokera ku Lechner, et al, 2021. "Jawbone Cavitation Yofotokozedwa RANTES/CCL5: Nkhani Zogwirizanitsa Kutupa Kwachete mu Jawbone ndi Epistemology ya Khansa ya M'mawere." Khansa ya M'mawere: Zolinga ndi Chithandizo

Appx 3 Chithunzi 2 Kuyerekeza kwa ma cytokines asanu ndi awiri (FGF-2, IL-1ra, IL-6, IL-8, MCP-1, TNF-a ndi RANTES) mu FDOJ pansi pa RFT #47 ndi ma cytokines m'nsagwada zathanzi.n = 19. Zolemba zophatikizira zowonjezera FDOJ m'chibwano chakumanja chakumanja, dera #47 la RFT #47, mosiyanitsa ndi wothandizira pambuyo pochotsa RFT #47.

Machaputala: FDOJ, fatty degenerative osteonecrosis ya nsagwada.

Adasinthidwa kuchokera ku Lechner ndi von Baehr, 2015. "Chemokine RANTES/CCL5 monga Ulalo Wosadziwika Pakati pa Kuchiritsa Kwachilonda mu Jawbone ndi Matenda a Systemic: Is Prediction and Tailored Treatments in the Horizon?" EPMA Journal

Chithunzi cha Appx III Njira yopangira opaleshoni ya retromolar BMDJ/FDOJ. Gulu lakumanzere: mutatha kupindika pansi pa mucoperiosteal flap, zenera la fupa linapangidwa mu kotekisi. Gulu lakumanja: kuchiritsa kwa medullary.

achidule: BMDJ, kuwonongeka kwa mafupa m'nsagwada; FDOJ, fatty degenerative osteonecrosis ya nsagwada.

Adasinthidwa kuchokera ku Lechner, et al, 2021. "Kutopa Kwambiri Syndrome ndi Bone Marrow Defects of the Jaw - A Case Report on Other Dental X-Ray Diagnostics with Ultrasound." International Medical Case Reports Journal

Chithunzi cha Appx III (a) Kuchiritsa kwa FDOJ m'nsagwada zapansi ndi mitsempha ya infra-alveolar. (b) Kulumikizana kwa X-ray popanda zizindikiro za pathological process mu nsagwada.

achidule: FDOJ, mafuta otsika osteonecrosis a nsagwada

Adasinthidwa kuchokera ku Lechner, et al, 2015. "Peripheral Neuropathic Facial / Trigeminal Pain ndi RANTES/CCL5 mu Jawbone Cavitation." Mankhwala Othandizira Omwe Amawathandiza

Appx III Kanema 1

Kanema wa kanema (dinani kawiri pachithunzichi kuti muwone kanema) wa opaleshoni ya nsagwada yomwe ikuwonetsa ma globules amafuta ndi zotulutsa zotuluka kuchokera ku nsagwada za wodwala yemwe akuganiziridwa kuti ali ndi nsagwada necrosis. Mwachilolezo cha Dr. Miguel Stanley, DDS

Appx III Kanema 2

Kanema wa kanema (dinani kawiri pachithunzichi kuti muwone kanema) wa opaleshoni ya nsagwada yomwe ikuwonetsa ma globules amafuta ndi zotulutsa zotuluka kuchokera ku nsagwada za wodwala yemwe akuganiziridwa kuti ali ndi nsagwada necrosis. Mwachilolezo cha Dr. Miguel Stanley, DDS

Kuti mutsitse kapena kusindikiza tsamba ili m'chinenero china, sankhani chinenero chanu kuchokera pa menyu otsika pamwamba kumanzere koyamba.

IAOMT Position Paper pa Human Jawbone Cavitations Authors