Kuti udhaunirodhe kana kuprinda peji ino mumutauro wakasiyana, sarudza mutauro wako kubva pane yekudonhedza pasi iri kumusoro kuruboshwe kutanga.

IAOMT Position Pepa paMunhu Jawbone Cavitations

Sachigaro weJawbone Pathology Committee: Ted Reese, DDS, MAGD, NMD, FIAOMT

Karl Anderson, DDS, MS, NMD, FIAOMT

Patricia Berube, DMD, MS, CFMD, FIAOMT

Jerry Bouquot, DDS, MSD

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

Dare racho rinoda kutaura kutenda kwedu kuna Michael Gossweiler, DDS, MS, NMD, Miguel Stanley, DDS naStuart Nunally, DDS, MS, FIAOMT, NMD nekuda kwekushoropodza kwavo bepa rino. Tinoshuvirawo kucherechedza zvipo zvakakosha uye kushanda nesimba kwakaitwa naDr. Nunnally mukunyora 2014 position bepa. Basa rake, kushinga uye kuita zvakapa musana weiyi bepa rakagadziridzwa.

Yakatenderwa neIAOMT Board of Directors Gunyana 2023

Table Of Contents

ziviso

History

kuongorora chirwere

Cone beam computed tomography (CBCT)

Ultrassom

Biomarkers uye Histological Examination

Evolving Mafungiro ezvinangwa zvekuongorora

Thermography

Acupuncture Meridian Assessment

Risk Factors

Systemic uye Clinical Implications

Kurapa Modalities

Alternative Treatment Strategies

mhedziso

References

Mashoko Okuwedzera I IAOMT Survey 2 Mhinduro

Mashoko Okuwedzera II IAOMT Survey 1 Mhinduro

Appendikisi III Images

Mufananidzo 1 Fatty degenerative osteonecrosis yeshaya (FDOJ)

Mufananidzo 2 Cytokines muFDOJ ichienzaniswa neHutano Kudzora

Mufananidzo 3 Kuvhiya maitiro eiyo retromolar FDOJ

Mufananidzo 4 Curettage uye inoenderana x-ray yeFDOJ

Mafirimu Vhidhiyo zvikamu zvekuvhiyiwa kweshaya muvarwere

NHANGANYAYA

Mumakore gumi apfuura kwave nekuwedzera kuziva pakati peveruzhinji uye vatarisiri vehutano hwekubatana pakati pehutano hwemuromo uye systemic. Semuenzaniso, chirwere cheperiodontal chinokonzera njodzi kune zvose chirwere cheshuga uye chirwere chemwoyo . Kubatana kungangove kwakakonzeresa uye kuwedzera kutsvagirwa kwakaratidzwa zvakare pakati peshaya dzeshaya uye hutano hwese uye simba remunhu. Kushandiswa kwehunyanzvi hwepamusoro hwekufungidzira maitiro senge cone-beam computed tomography (CBCT) yakabatsira mukuziva mazamu eshaya, izvo zvakakonzera kuvandudza kugona kwekuongorora uye kugona kwakavandudzika kuongorora kubudirira kwekuvhiya. Scientific mishumo, docudramas uye social media zvakawedzera kuziva kweveruzhinji nezveizvi pathologies, kunyanya pakati peavo vanhu vanotambura neasingatsananguriki asingaperi neurological kana systemic mamiriro anotadza kupindura kune yechinyakare kurapwa kana mazino kupindira.

Iyo International Academy yeOral Medicine uye Toxicology (IAOMT) yakavakirwa pakutenda kuti sainzi inofanirwa kuve hwaro huchasarudzwa uye kushandiswa nzira dzese dzekuongorora nekurapa. Zviri nekutanga izvi mupfungwa kuti isu 1) tinopa iyi vhezheni kune yedu 2014 IAOMT Jawbone Osteonecrosis Position Pepa, uye 2) kurudzira, zvichibva pane histological kucherechedza, zita resainzi uye rekurapa rakarurama rechirwere, kunyanya, Chronic Ischemic Medullary Disease. yeJawbone (CIMDJ). CIMDJ inotsanangura chirwere chebhonzo chinoratidzwa nekufa kwezvikamu zvemasero e-cancelous bone, yechipiri kusvika pakukanganiswa kweropa. Munhoroondo yayo yese, zvatiri kureva seCIMDJ zvave zvichitaurwa nezvakawanda zvemazita uye acronyms zvakanyorwa muTebhu 1 uye zvichakurukurwa muchidimbu pazasi.

Chinangwa uye chinangwa cheChikoro ichi uye pepa ndechekupa sainzi, tsvakurudzo, uye kuongororwa kwekliniki kune varwere nevarapi kuti vaite zvisarudzo zvine ruzivo pavanofunga nezvezvipembenene izvi zveCIMDJ, izvo zvinowanzonzi jawbone cavitations. Iri bepa ra2023 rakagadzirwa mukubatana kwaisanganisira varapi, vaongorori uye ane mukurumbira wemapfupa eshaya, Dr. Jerry Bouquot, zvichitevera kuongororwa kwezvinyorwa zvinopfuura mazana maviri nemakumi manomwe.

NHOROONDO

Hapana rimwe bhonzo rinokwanisa kukuvara uye zvirwere zvakakura semushaya. Ongororo yezvinyorwa zvine chekuita nemusoro wejawbone cavitations, (kureva, CIMDJ) inoratidza kuti chirwere ichi chakaonekwa, kurapwa nekutsvagirwa kubva kuma1860. Muna 1867, Dr. HR Noel akapa mharidzo ine musoro Chidzidzo che caries uye necrosis yemapfupa paBaltimore College yeDental Surgery, uye muna 1901 jawbone cavitations inokurukurwa kwenguva refu naWilliam C. Barrett mubhuku rake rinonzi, Oral Pathology and Practice: A Textbook for the Use of Students in Dental Colleges uye Handbook for Dental Practitioners . GV Black, anowanzonzi ndiye baba vemazino emazuva ano, aisanganisira chikamu mubhuku rake ra1915, Special Dental Pathology, kurondedzera 'kuonekwa uye kurapwa kwakajairika' kwaakatsanangura sejawbone osteonecrosis (JON) .

Tsvagiridzo pamusoro pejawbone cavitations yakaita seyakamira kusvika kuma1970 apo vamwe vakatanga kuferefeta musoro wenyaya, vachishandisa mazita akasiyana-siyana uye mavara, uye kubudisa ruzivo pamusoro payo mumabhuku emazuva ano oral pathology. Somuenzaniso, muna 1992 Bouquot et al akacherechedza intraosseous kuzvimba kune varwere vane kurwadziwa kusingaperi uye kwakanyanya kwechiso (N = 135) uye vakagadzira izwi rokuti 'Neuralgia-inducing Cavitational Osteonecrosis', kana NICO. Kunyange zvazvo Bouquot et al vasina kutaura nezve etiology yechirwere, vakagumisa kuti zvingangoitika kuti zvipembenene zvakakonzera chirwere chisingaperi chechiso neuralgia nemhando dzakasiyana dzenharaunda: intraosseous cavity formation uye kwenguva yakareba bone necrosis ine kuporesa kuduku. Muchidzidzo chekiriniki chevarwere vane trigeminal (N = 38) uye chiso (N = 33) neuralgia, Ratner et al, akaratidzawo kuti vanenge vose varwere vaiva nemakumbo mumapfupa ealveolar uye jawbone. Iwo maburi, dzimwe nguva anopfuura 1 centimita muhupamhi, aive panzvimbo dzekubviswa mazino apfuura uye aisawanzoonekwa ne x-ray.

Mamwe mazwi akasiyana ezvatinozivisa seCIMDJ aripo mumabhuku. Izvi zvakanyorwa muTable 1 uye zvakakurukurwa muchidimbu pano. Adams et al vakagadzira izwi rekuti Chronic Fibrosing Osteomyelitis (CFO) mune 2014 chinzvimbo bepa. Pepa renzvimbo iyi raive mhedzisiro yemubatanidzwa wemarudzi akawanda evarapi kubva kuminda yeOral Medicine, Endodontics, Oral Pathology, Neurology, Rheumatology, Otolaryngology, Periodontology, Psychiatry, Oral uye Maxillofacial Radiology, Anesthesia, General Dentistry, Internal Management, uye Paintology. . Chinangwa cheboka chaive chekupa chikuva chekudyidzana kurapa zvirwere zvine chekuita nemusoro, mutsipa, uye kumeso. Kuburikidza nekuedza kwakaungana kweboka iri, kutsvaga kwemabhuku kwakawanda uye kubvunzurudzwa kwevarwere, imwe nzira yekiriniki yakabuda, iyo yavakadaidza seCFO. Vakataura kuti chirwere ichi hachiwanzoonekwa nekuda kwekusangana kwacho nemamwe maitiro ehurongwa. Boka iri rakaratidza hukama hunogona kuitika pakati pechirwere uye systemic hutano nyaya uye kudiwa kwechikwata chevarapi kuti vanyatsoongorora uye kurapa murwere.

Jawbone cavitational maronda akaonekwawo muvana. Muna 2013, Obel et al akatsanangura maronda muvana uye akagadzira izwi rekuti Juvenile Mandibular Chronic Osteomyelitis (JMCO). Iri boka rakakurudzira kushandiswa kwe intravenous (IV) bisphosphonates sekurapa kwevana ava. Muna 2016 Padwa et al akaburitsa chidzidzo chinotsanangura focal sterile inflammatory osteitis muvarwere veshaya'mapfupa. Vakanyora chironda chePediatric Chronic Nonbacterial Osteomyelitis (CNO).

Kubva 2010, Dr. Johann Lechner, munyori anonyanya kubudiswa uye muongorori pamusoro pejawbone cavitational lesions, uye vamwe vave vachitsvakurudza hukama hwezvipembenene izvi kune kugadzirwa kwe cytokine, kunyanya kuputika kwe cytokine RANTES (inozivikanwawo seCCL5). Dr. Lechner akashandisa mazwi akasiyana-siyana kutsanangura maronda aya akabatanidza NICO yakambotaurwa asiwo Aseptic Ischemic Osteonecrosis muJawbone (AIOJ), uye Fatty Degenerative Osteonecrosis yeJawbone (FDOJ) . Tsananguro yake/chinyorwa chakavakirwa pachitarisiko chemuviri uye/kana iyo macroscopically pathological mamiriro ari kucherechedzwa kiriniki kana intraoperatively.

Ikozvino pave kuda kujekesa imwe nguva ichangoburwa yakaonekwa yejojo ​​pathosis iyo yakasiyana nemusoro webepa rino asi inogona kuvhiringa kune avo vari kutsvagisa cavitational maronda. Aya maronda emapfupa eshaya anomuka nekuda kwekushandiswa kwemishonga. Maronda acho anoonekwa zvakanyanya nekurasikirwa kweropa nekutevera kusingadzoreki sequestration yebhonzo. Maronda aya anonzi Oral Ulceration with Bone Sequestration (OUBS) naRuggiero et al mubepa renzvimbo. American Association of Oral uye Maxillofacial Vanachiremba (AAOMS), pamwe chete naPalla et al, mukuongorora kwakarongeka. Sezvo dambudziko iri rakabatana nekushandiswa kweimwe kana yakawanda mishonga yemishonga, IAOMT ndeyepfungwa yekuti rudzi urwu rwechirwere chinonyanya kutsanangurwa seMedication-related Osteonecrosis yeJaw (MRONJ). MRONJ haizokurukurwa mupepa rino sezvo etiology yayo uye nzira dzekurapa dzakasiyana neiyo yatiri kutaura nezvayo seCIMDJ, uye yakambodzidzwa zvakanyanya.

Chirwere

Kuwedzera kushandiswa kweCone-beam computed tomography (CBCT) radiographs nevarapi vemazino vakawanda kwakakonzera kuwedzera kwekuchengetwa kwe intramedullary cavitations yatinoti CIMDJ, uye iyo yakambofuratirwa uye saka isingatauriki. Zvino izvo maronda aya uye anomalies anyanya kuzivikanwa, rinova basa rebasa remazino kuongorora chirwere ichi uye kupa kurudziro yekurapa uye kutarisirwa.

Kukoshesa uye kuona kuvepo kweCIMDJ ndiyo yekutanga yekuinzwisisa. Pasinei nemazita akawanda uye acronyms akave akabatanidzwa nehutachiona, kuvapo kwenecrotic, kana kufa kwepfupa mumedullary chikamu cheshaya yakasimbiswa zvakanaka.

Kana ichionekwa panguva yekuvhiyiwa uku kukanganisa kwebhoni kunozviratidza nenzira dzakawanda. Vamwe varapi vanotaura kuti anopfuura makumi manomwe neshanu muzana emaronda akazara kana akazadzwa neakapfava, greyi-brown uye demineralized/granulomatis tishu, kazhinji nemafuta eyero (oiri cysts) anowanikwa munzvimbo dzakaremara dzine akatenderedza bhonzo anatomy. Vamwe vanotaura nezvehuvepo hwema cavitations ane cortical bone density yakasiyana-siyana iyo pakuvhurwa, inoita kunge ine maraning ane fibrous dema, brown kana grey filamentous materials. Vamwewo vanoshuma kuchinja kwakakura kwakasiyana-siyana kunotsanangurwa se "gritty", "sesawdust", "hollow cavities", uye "kuoma" pamwe neapo neapo sclerotic, kuoma kwemazino kumadziro emhango. Pamusoro pekuongorora histological, zvipembenene izvi zvinoratidzika zvakafanana necrosis inowanikwa mune mamwe mapfupa emuviri uye ndeye histologically yakasiyana neosteomyelitis (Ona Mufananidzo 75). Mimwe mifananidzo inoratidza chirwere cheCIMDJ, mimwe ine graphic muchimiro, inosanganisirwa muAppendix III pakupera kwegwaro rino.

Mufananidzo 1 Mifananidzo yeCIMDJ yakatorwa kubva kucadaver

Kufanana nevamwe varapi vehutano, vanachiremba vemazino vanoshandisa nzira yakarongeka inoshandisa nzira dzakasiyana siyana uye maitiro ekuongorora maronda ecavitational. Izvi zvinogona kusanganisira kuongororwa kwemuviri kunosanganisira kutora nhoroondo yehutano, kuongorora zviratidzo, kuwana zvinwiwa zvemuviri kuti uedze ongororo murabhoritari, uye kuwana masampula enyama yebiopsy uye yekuongorora hutachiona (kureva, kuongororwa kuvepo kwehutachiona). Imaging matekinoroji, akadai seCBCT anowanzoshandiswa. Mune varwere vane matambudziko akaomarara asingawanzo kutevedzera maitiro kana kuenderana neyakajairwa kurongeka kwechiratidzo chakaoma, chirongwa chekuongorora chinogona kuda kuongororwa kwakadzama uko pakutanga kungangoguma nekusiyana kwekuongororwa. Tsanangudzo pfupi dzeakawanda eiyi nzira dzekuongorora dzinopihwa pazasi.

Cone beam computed tomography (CBCT)

Nzira dzekuongorora dzakarondedzerwa kare kare muna 1979 naRatner uye vaaishanda navo, vachishandisa digital palpation uye kudzvinyirirwa, diagnostic local anesthetic injections, kufunga nezvenhoroondo dzezvokurapa uye nzvimbo yemarwadzo anopenya anobatsira pakuongorora jawbone cavitations. Zvisinei, nepo zvimwe zvezvironda izvi zvichikonzera marwadzo, kuzvimba, kutsvuka uye kunyange fivha, vamwe havadaro. Nokudaro, chiyero chakanyanya chinangwa, chakadai sekufungidzira chinowanzodiwa.

Macavitations kazhinji haaonekwe pachiyero maviri dimensional (2-D senge, periapical uye panoramic) radiographic mafirimu anowanzo shandiswa mukurapa mazino. Ratner uye vaaishanda navo vakaratidza kuti 40% kana kupfuura yepfupa inoda kuchinjwa kuratidza kuchinja, uye izvi zvinotsigirwa nekushanda gare gare, uye inoratidzwa mumufananidzo 2. Izvi zvakabatana nemuganhu wepakati we 2-D imaging iyo inokonzera superimposition. yezvimiro zveanatomical, masking nzvimbo dzekufarira. Panyaya yekuremara kana pathology, kunyanya mune mandible, iyo masking maitiro e dense cortical bone pane ari pasi zvimiro anogona kuve akakosha. Naizvozvo, tekinoroji yepamusoro yekufungidzira seCBCT, Tech 99 scans, magnetic resonance imaging (MRI), kana trans-alveolar ultrasound sonography (CaviTAU™®) inodiwa.

Pakati pemaitiro akasiyana-siyana ekufungidzira anowanikwa, CBCT ndiyo inonyanya kushandiswa yekuongorora inoshandiswa nemazino anobatanidzwa mukuongorora kana kurapa cavitations, uye naizvozvo iyo yatichakurukura zvakadzama. Ibwe rekona reCBCT tekinoroji kugona kwayo kuona chironda chekufarira muzvikamu zvitatu (mberi, sagittal, coronal). CBCT yakaratidza kuva nzira yakavimbika uye yakarurama yekuziva nekufungidzira ukuru uye hupamhi hwehurema hwemukati-bhoni mushaya ine kukanganiswa kudiki uye kukudza kushoma pane 3-D x-ray.

Mufananidzo 2 Tsanangudzo: Kudivi rekuruboshwe kunoratidzwa 2-D radiographs yeshaya dzakatorwa kubva mumakumbo anooneka.

utano. Kurutivi rwerudyi rwechifananidzo kune mapikicha emafupa akafanana anoratidza pachena necrotic cavitation.

Mufananidzo wakatorwa kubva kuBouquot, 2014.

Zvidzidzo zvekiriniki zvakaratidza mifananidzo yeCBCT inobatsirawo pakuona zviri mukati mechirwere (fluid-filled, granulomatous, solid, etc.), zvichida kubatsira kusiyanisa pakati pezvipembenene zvinoputika, odontogenic kana non-odontogenic tumors, cysts, uye mamwe maronda kana akaipa. maronda .

Ichangoburwa software yakanyatsobatanidzwa nemhando dzakasiyana dzeCBCT zvishandiso inoshandisa Hounsfield units (HU) iyo inobvumira kuongororwa kwakamisikidzwa kwehuwandu hwemapfupa. HU inomiririra kuwanda kwezvinyama zvemuviri zvinoenderana nechiyero chegrey-level, zvichienderana nehukoshi hwemhepo (-1000 HU), mvura (0 HU), uye kusimba kwebhonzo (+1000 HU). Mufananidzo 3 unoratidza maonero akasiyana echifananidzo chemazuva ano cheCBCT.

Kupfupisa, CBCT yakaratidza kubatsira mukuongororwa uye kurapwa kwejawbone cavitations ne:

1. Kuziva saizi, kureba uye 3-D chinzvimbo cheronda;
2. Kuziva kuswedera kweronda kune mamwe maatomical akakosha ari pedyo akadai se

yakaderera alveolar nerve, maxillary sinus, kana midzi yezino iri pedyo;

1. Kusarudza nzira yekurapa: kuvhiyiwa kunopesana nekusavhiya; uye
2. Kupa mufananidzo wekutevera kuti uone chiyero chekuporesa uye chinogoneka chinodiwa

kurapa zvakare chironda.

Mufananidzo 3 Yakavandudzwa kujeka kwemufananidzo weCBCT nekuda kwekunatswa kwesoftware tekinoroji, iyo inoderedza zvigadzirwa uye "ruzha" iyo mazino anodyara uye kudzoreredzwa kwesimbi kunogona kukonzera mumufananidzo. Izvi zvinobvumira chiremba wemazino uye murwere kuti aone chironda chacho zviri nyore. Iyo yepamusoro pani pane panoramic maonero eCBCT inoratidza kuruboshwe (#17) uye kurudyi (#32) nzvimbo uye hupamhi hwemaronda e cavitational mujawbone osteonecrosis murwere. Pazasi kuruboshwe mapaneru ndeye sagital maonero ega ega saiti. Pazasi kurudyi pane 3-D inopa yesaiti #17 inoratidza cortical porosity overlying medullary cavitation. Nekuda kwaDr. Reese.

Ultrassom

Isu tinotaurawo muchidimbu pano mudziyo we ultrasound, iyo CaviTAU™®, iyo yakagadziridzwa uye iri kushandiswa munzvimbo dzeEurope, kunyanya kuona nzvimbo dzakaderera dzemafupa epamusoro uye ezasi mabhonzo eshaya ayo anoratidza ejawbone cavitations. Iyi trans-alveolar ultrasonic sonography (TAU-n) mudziyo unogona kuenzana kana uchienzaniswa neCBCT mukuona kukanganisika kwemwongo weshaya, uye ine bhenefiti yakawedzerwa yekufumura murwere kumazinga akaderera emwaranzi. Ichi chishandiso parizvino hachiwanikwe muUS asi chiri kuongororwa neUS Chikafu neDrug Administration uye chinogona kunge chiri chishandiso chekutanga chekuongorora chinoshandiswa muNorth America kurapa CIMJD.

Biomarkers uye Histological Examination

Nekuda kwekuzvimba kwejawbone cavitations Lechner naBaehr, 2017 vakaongorora hukama hunogona kuitika pakati pekusarudza cytokines nechirwere. Imwe cytokine inonyanya kufarira 'inodzorwa pakuita, yakajairika T-sero rinoratidzwa uye rakavanzwa' (RANTES). Iyi cytokine, pamwe chete nefibroblast growth factor (FGF) -2, inoratidzirwa muhuwandu hwakawanda mumakumbo emakumbo uye kune varwere vane CIMDJ. Mufananidzo 4, wakapiwa naDr. Lechner, unoenzanisa mazinga eRANTES kune varwere vane cavitations (tsvuku tsvuku, kuruboshwe) nemazinga muhutano hwehutano (blue bar), kuratidza mazinga anopfuura 25 nguva huru kune avo vane chirwere. Lechner et al anoshandisa nzira mbiri dzekuyera mazinga e cytokine. Imwe ndeyekuyera mazinga e cytokines systemically kubva muropa (Diagnostic Solutions Laboratory, US.). Yechipiri nzira ndeyekutora biopsy yakananga kubva kune inorwara saiti kana yasvika kuti iongororwe neoral pathologist. Nehurombo, panguva ino yemuno yetishu sampling inoda kugadzirwa kwakaoma uye kutumira izvo zvichiri kuzowanikwa munzvimbo dzisiri dzekutsvaga, asi zvakapa hukama hunonzwisisa.

Mufananidzo 4 Kugoverwa kweRANTES mune makumi matatu neshanu FDOJ makesi uye gumi nemapfumbamwe masampula eyakajairika jawbone mukuenzanisa ne x-ray density referensi yemapoka ese ari munzvimbo dzinoenderana. Mapeji: RANTES, inodzorwa pakuita, yakajairika T-sero inoratidzwa uye yakavanzika chemokine (CC motif) ligand 5; XrDn, X-ray density; FDOJ, fatty degenerative osteonecrosis yeshaya; n, nhamba; Ctrl, control. Mufananidzo wakapihwa naDr. Lechner. Rezinesi nhamba: CC BY-NC 3.0

Evolving Mafungiro ezvinangwa zvekuongorora

Kuvapo kwejawbone cavitations kwakanyatso kusimbiswa nekiriniki. Nekudaro, akajeka ekuongororwa uye akanakisa maitiro ekurapa paramita anoda kumwe kutsvagisa. Tichifunga izvozvo zvakakosha kuti titaure muchidimbu maitiro mashoma anokatyamadza uye angangove akakosha ari kushandiswa nevamwe varapi.

Thermography

Izvo zvinozivikanwa kuti kuwedzera physiologic ongororo ingave yakakosha yekuongorora uye yekuongorora chishandiso. Chimwe chishandiso chiri kushandiswa nevamwe varapi ndeye thermographic imaging. Generalized inflammatory activity inogona kuonekwa nekuyera kusiyana kwekupisa pamusoro pemusoro nemutsipa. Thermography yakachengeteka, inokurumidza uye inogona kuva nehutano hwekuongorora hwakafanana neiyo yeCBCT. Chinhu chakakosha kudzoka ndechekuti haina tsananguro, zvichiita kuti zviome kuona muganho kana mwero weronda.

Acupuncture Meridian Assessment

Vamwe varapi vari kutarisa kusimba kwechimiro cheronda vachishandisa Acupuncture Meridian Assessment (AMA) kuti vaone mhedzisiro yayo pane inowirirana simba meridian. Iyi mhando yekuongorora yakavakirwa muElectroacupuncture Maererano neVoll (EAV) . Iyi nzira, iyo yakavakirwa pamishonga yekare yeChinese uye nheyo dzeacupuncture, yakagadziridzwa uye iri kudzidziswa muUS. Acupuncture yakashandiswa kuderedza marwadzo uye kukurudzira kupora. Inobva pachiyero chekuyerera kwesimba (kureva, Chi) kuburikidza nenzira dzakananga dzesimba mumuviri. Idzi nzira, kana meridians, dzinobatanidza nhengo dzakati, matishu, tsandanyama uye mapfupa kune mumwe nemumwe. Acupuncture inoshandisa mapoinzi chaiwo pane meridian kukanganisa hutano uye simba rezvinhu zvese zvemuviri pane iyo meridian. Iyi nzira yakashandiswa kuratidza chirwere cheshaya, iyo kana yagadziriswa, inobatawo zvirwere zvinoita sezvisina hukama, zvakadai searthritis kana chronic fatigue syndrome. Iyi nzira inokweretesa kuenderera mberi nekuferefeta (kureva, mhedzisiro inoda kunyorwa uye data rerefu rinowanikwa nekuparadzirwa).

DZIVA ZVINOKOSHA

Pane zvakawanda zvemunhu zvinowedzera njodzi yekuvandudzwa kwejawbone cavitations asi kazhinji njodzi ndeye multifactorial. Njodzi kumunhu dzinogona kunge dziri pesvedzero yekunze, senge zvakatipoteredza kana zvemukati pesvedzero, zvakadai sekushaya simba kwekudzivirira muviri. Matafura 2 uye 3 anonyora kunze uye mukati mengozi zvinhu.

Ziva kuti Tafura 2, Internal Risk Factors, haisanganisi genetic predisposition. Nepo kusiyana kwemajini kwaizofungwa kuita basa, hapana kusiyanisa kwemajini kana kunyange kusanganiswa kwemajini kwakaratidzwa kuve kunoonekwa sechinhu chinokonzera njodzi, zvisinei maitiro emajini anogona kuitika. . Ongororo yakarongeka yemabhuku yakaitwa muna 2019 yakaratidza kuti akati wandei nucleotide polymorphisms akaonekwa, asi hapana kudzokorora pane zvidzidzo. Vanyori vakagumisa kuti vakapa zvakasiyana-siyana zvemajini zvakaratidza kushamwaridzana kwakanaka ne cavitations uye kushayikwa kwekuberekazve kwezvidzidzo, basa rinoitwa nemararamiro ezvikonzero zvingaita sezvine mwero uye zvakasiyana. Zvakadaro, kunanga vanhu chaivo kungave kuri madikanwa kuziva misiyano yemajini. Zvechokwadi, sezvakaratidzirwa, imwe yenzira dzakajairika uye dzinokosha dzepathophysiologic dze ischemic bone kukuvadzwa kunowedzera kuvhara kubva kune hypercoagulation states, iyo inowanzove ine genetic underpinnings, sezvinotsanangurwa naBouquot naLamarche (1999) . Tafura 4 yakapiwa naDr. Bouquot, inonyora chirwere chinotaura chinosanganisira hypercoagulation uye ndima dzinotevera dze3 dzinopa mhedziso yezvimwe zvakawanikwa naDkt.

Mujawbone cavitations kune uchapupu hwakajeka hwe ischemic osteonecrosis, iyo chirwere chepfupa umo pfupa rinova necrotic nekuda kweokisijeni uye kushayikwa kwezvokudya. Sezvambotaurwa, zvinhu zvakawanda zvinogona kudyidzana kugadzira cavitations uye vanosvika 80% yevarwere vane dambudziko, rinowanzogarwa nhaka, rekunyanyisa kugadzirwa kweropa mutsinga dzeropa. Chirwere ichi hachiwanzoratidzwa panguva yekuongororwa ropa nguva dzose. Bone inonyanya kutarisana nechinetso ichi che hypercoagulation uye inovandudza mitsipa yeropa yakanyanya; kuwedzera, kazhinji kunorwadza, dzvinyiriro dzomukati; kudzikama kweropa; uye kunyange infarctions. Iri dambudziko re hypercoagulation rinogona kuratidzirwa nenhoroondo yemhuri yesitiroko uye kurohwa kwemoyo pazera rechidiki (pasi pemakore makumi mashanu nemashanu), kutsiva hudyu kana "arthritis" (kunyanya pazera rediki), osteonecrosis (kunyanya pazera diki), yakadzika. Vein thrombosis, pulmonary emboli (blood clots mumapapu), retinal vein thrombosis (maclots mu retina yeziso) uye kubuda kwepamuviri kunowanzoitika. Mashaya ane 55 matambudziko chaiwo ane chirwere ichi: 2) kana yaparadzwa, pfupa rinorwara harina kukwanisa kutsungirira zvirwere zvakaderera kubva kunezino uye gum bacteria; uye 1) pfupa haringagoni kupora kubva pakuderera kwekuyerera kweropa kunokonzerwa neanesthetics yemunharaunda inoshandiswa nemazino panguva yebasa remazino. Mufananidzo 2 inopa microscopic maonero e intravascular thrombus.

Tafura 4 Chirwere chinoti chinosanganisira hypercoagulation. Vana kubva kune vashanu jawbone cavitation varwere vane imwe yeiyi kuvhara

factor matambudziko.

Pasinei nechikonzero chinokonzera hypercoagulation, pfupa rinoita kana fibrous marrow (fibers inogona kugara munzvimbo dzine nzara yezvokudya), mafuta, akafa akafa ("wet rot"), yakaoma zvikuru, dzimwe nguva yeganda ("dry rot" ), kana nzvimbo isina mhango yakakwana ("cavitation").

Chero pfupa rinogona kukanganiswa, asi mahudyu, mabvi uye shaya zvinowanzobatanidzwa. Marwadzo anowanzo kuoma asi anenge 1/3^rd yevarwere havanzwi kurwadziwa. Muviri une dambudziko rekuzviporesa kubva kuchirwere ichi uye 2/3^rds dzemakesi dzinoda kuvhiyiwa kubviswa kwemwongo yakakuvadzwa, kazhinji nekukweshwa nema curettes. Kuvhiya kunobvisa dambudziko (uye kurwadziwa) munenge 3/4^ths yevarwere vane kubatanidzwa kweshaya, kunyange kudzokorora kuvhiyiwa, kazhinji maitiro maduku pane ekutanga, anodiwa mu40% yevarwere, dzimwe nguva mune dzimwe nzvimbo dzeshaya, nokuti chirwere chacho chinowanzova ne "skip" maronda (kureva, nzvimbo dzakawanda mu mapfupa akafanana kana akafanana), ane mwongo wakajairika pakati. Vanopfuura hafu yevarwere vehudyu vanozopedzisira vawana chirwere muhudyu yakatarisana. Kupfuura 1/3^rd yevarwere veshaya vachawana chirwere mune mamwe maquadrants eshaya. Munguva pfupi yapfuura, zvakaonekwa kuti 40% yevarwere vane osteonecrosis yehudyu kana shaya vachapindura anticoagulation ne low molecular weight heparin (Lovenox) kana Coumadin nekugadzirisa marwadzo uye nekuporesa kwepfupa.

Mufananidzo 5 Microscopic maonero e intravascular thrombi

Kana uchitsvaga nzira isiri yemishonga yekudzikisa njodzi ye hypercoagulation munhu anogona kufunga nezve kushandiswa kwema enzymes ekuwedzera akadai se nattokinase kana iyo yakanyanya simba lumbrokinase ese ane fibrinolytic uye anticoagulation properties. Mukuwedzera, kushayikwa kwemhangura inotaura, iyo inobatanidza nekushaya simba kwekugadzirisa, inofanira kubviswa nekuda kwekuwedzera kwengozi ye hypercoagulation inoonekwa kune varwere vane jawbone cavitations.

SYSTEMIC UYE CLINICAL IMPLICATIONS

Kuvapo kwejawbone cavitations uye yavo yakabatana pathology inosanganisira zvimwe zviratidzo asi kazhinji inosanganisira zvimwe zvisiri-chaiyo systemic zviratidzo. Nokudaro, kuongororwa kwayo uye kurapwa kunofanira kusvikirwa nekunyatsotariswa neboka rekutarisira. Izvo zvakanyanya kusarudzika uye zvinokatyamadza zvakaonekwa kubva paIAOMT 2014 chinzvimbo bepa ndiko kugadziriswa kwezvinoita sezvisingaenderane zvisingaperi zvekuzvimba mamiriro ekutevera kurapwa kwecavitation. Kunyangwe chirwere chesystemic chiri chechimiro che autoimmune kana kuzvimba kunoitika neimwe nzira, kuvandudzwa kwakanyanya kwakataurwa, kusanganisira kuvandudzwa kwegomarara. Chiratidzo chakaoma chakabatana nemaronda aya chakanyanya kusarudzwa uye saka hazvigoneke kana kuoneka zviri nyore. Nokudaro, iyo IAOMT ndeyepfungwa yekuti kana murwere akaonekwa kuti ane jawbone cavitations ane kana asina marwadzo anowanikwa munharaunda, uyewo ane humwe hutachiona hwehutachiona hwaimbova husina kukonzerwa nejawbone cavitations, murwere anoda kumwe kuongororwa kuti aone kana chirwere chacho chakabatana , kana kuti mhedzisiro yechirwere. IAOMT yakaongorora nhengo dzayo kuti dzidzidze zvakawanda nezve izvo systemic zviratidzo / hurwere hunogadziriswa zvichitevera kuvhiyiwa kwecavitational. Mhedzisiro yakapihwa muAppendix I.

Kuvapo kwema cytokines anogadzirwa mune zvisina kunaka vascularized, necrotic maronda ejawbone cavitations anoita senge anotarisa anopisa ma cytokines anochengeta dzimwe nzvimbo dzekuzvimba kushanda uye / kana kusingaperi. Kusununguka kana kuti kumbovandudzika kubva kumarwadzo ekushaya shaya mushure mekurapwa kunotarisirwa uye kunotarisirwa, asi iyi dzidziso yekuzvimba, iyo ichakurukurwa zvakadzama pazasi, inogona kutsanangura chikonzero nei akawanda anoratidzika kunge 'asina hukama' zvirwere zvine chinongedzo nekusingaperi kuzvimba mamiriro. vanodzikiswawo necavitation kurapwa.

Mukutsigira mhedziso dzakatorwa mu IAOMT's 2014 chinzvimbo bepa rinobatanidza jawbone cavitations uye systemic zvirwere, tsvagiridzo uye zvidzidzo zvekiriniki zvakaburitswa nguva pfupi yapfuura naLechner, von Baehr nevamwe, zvinoratidza kuti jawbone cavitation maronda ane chaiyo cytokine mbiri isingaonekwe mune mamwe mapfupa pathology. . Kana ichienzaniswa neyakagadzikana jawbone samples, cavitation pathologies inoramba ichiratidza kusimba kwakasimba kwefibroblast growth factor (FGF-2), Interleukin 1 receptor antagonist (Il-1ra), uye, kunyanya kukosha, RANTES. RANTES, inozivikanwawo se CCL5 (cc motif Ligand 5) yakatsanangurwa sechemotactic cytokine ine simba reproinflammatory action. Aya machemokines akaratidzwa kupindira mumatanho akati wandei ekupindura kwe immune uye akabatanidzwa zvakanyanya mumamiriro akasiyana ezvirwere uye hutachiona. Zvidzidzo zvakaratidza kuti RANTES ine chekuita nezvirwere zvakawanda zvehurongwa zvakaita searthritis, chronic fatigue syndrome, atopic dermatitis, nephritis, colitis, alopecia, kusagadzikana kwethyroid uye kukurudzira kwemultiple sclerosis uye chirwere cheParkinson. Kupfuurirazve, RANTES yakaratidzwa kukonzera kukurumidza kwebundu kukura.

Fibroblast kukura zvinhu zvakabatanidzwawo mujawbone cavitations. Iyo Fibroblast kukura zvinhu, FGF-2, uye yakabatana mareceptors, ane basa rekuita akawanda akakosha mabasa, anosanganisira kuwanda kwesero, kurarama, uye kutama. Ivo zvakare vanokonzeresa kubirwa nemaseru egomarara uye kutamba basa reoncogenic mumakenza mazhinji. Semuenzaniso, FGF-2 inokurudzira bundu uye kukura kwekenza mukenza yeprostate. Pamusoro pezvo, FGF-2 mazinga akaratidza kuwirirana kwakananga kune kufambira mberi, metastasis uye kusapona kwekufanotaura mune colorectal cancer varwere. Kuenzaniswa nekudzora-isina kenza, varwere vane gastric carcinoma vane mazinga akanyanya eFGF-2 muserum yavo. Nhume dzinopisa idzi dzakabatanidzwa muzvirwere zvakawanda zvakakomba zvingave zvekuzvimba kana kenza. Kusiyana neRANTES/CCL5 uye FGF-2, IL1-ra yakaratidzwa kuita semurevereri akasimba anopesana nekuputika, zvichiita kuti kushayikwa kwezviratidzo zvinowanzovhiringidza mukati memamwe maronda e cavitation.

Iwo akawandisa mazinga eRANTES uye FGF-2 mune cavitation maronda akafananidzwa uye akabatanidzwa nemazinga anocherechedzwa mune zvimwe systemic zvirwere seamyotrophic lateral sclerosis, (ALS) multiple sclerosis (MS), rheumatoid arthritis uye kenza yemazamu. Chokwadi, mazinga evatumwa aya akaonekwa mujawbone cavitations akakwira kupfuura muserum uye cerebrospinal fluid yevarwere veALS neMS. Tsvagiridzo yazvino naLechner na von Baehr yakaratidza kuwedzera kwe26-kakapetwa muRANTES mujawbone osteonecrotic maronda evarwere vekenza yemazamu. Lechner uye vaanoshanda navo vanokurudzira cavitation inotorwa RANTES inogona kushanda seanomhanyisa kukura kwegomarara rezamu uye kufambira mberi.

Sezvambotaurwa, kune dzakawanda zviitiko zveasymptomatic jawbone cavitations. Muzviitiko izvi, acute pro-inflammatory cytokines akadai seTNF-alpha uye IL-6, HAZVINHU kuonekwa muhuwandu hwehuwandu mune pathohistological yakawanikwa ye cavitation samples. Mune varwere ava, kusavapo kweiyi pro-inflammatory cytokines inosanganiswa nepamusoro-soro ye-anti-inflammatory cytokine Interleukin 1-receptor antagonist (Il-1ra). Mhedziso inonzwisisika ndeyekuti kuzvimba kwakanyanya kwakabatana nejawbone cavitations kuri pasi pekutonga kwemazinga akakwira eRANTES/FGF-2. Somugumisiro, kuita chirwere, Lechner na von Baehr vanoratidza de-kusimbisa kutarisa kwekuvapo kwekuputika uye funga nzira yechiratidzo, kunyanya kuburikidza nepamusoro pekutaura kweRANTES/FGF-2. Iyo yakakwirira yeRANTES/FGF-2 mu cavitation varwere inoratidza kuti maronda aya angave ari kukonzera zvakafanana uye pamwe chete kusimbisa pathogenic masaini nzira kune dzimwe nhengo. Iwo immune system inogadziriswa mukupindura kune njodzi masaini, ayo anomutsa akasiyana-siyana emukati mamorekuru nzira dzinoguma nekuzvimba cytokine kugadzirwa uye zvinogona kuita activative immune system. Izvi zvinotsigira pfungwa uye dzidziso, yekuti jaw bone cavitations inogona kushanda sechikonzero chakakosha chezvirwere zvisingaperi zvinoputika kuburikidza neRANTES/FGF-2 kugadzirwa uyezve inotsanangura kuti sei zviratidzo zvakanyanya zvekuzvimba zvisingaonekwe kana kunzwika nemurwere mumaronda eshaya. pachavo. Nokudaro, jawbone cavitations uye idzi dzakabatanidzwa vatumwa dzinomiririra chikamu chekubatanidza chechirwere chinoputika uye inoshanda sechinhu chinogona kuitika chechirwere. Kubvisa cavitations kunogona kuva kiyi yekudzoreredza zvirwere zvinoputika. Izvi zvinotsigirwa nekucherechedza kuderedzwa kweserum RANTES mazinga mushure mekuvhiyiwa kupindira mune 5 varwere vekenza yemazamu (Ona Tafura 5). Kuwedzera kutsvagisa uye kuyedzwa kweRANTES/CCL5 mazinga anogona kupa ruzivo muhukama uhu. Zvinokurudzira zvinocherechedzwa ndiko kuvandudzwa kwehupenyu hwehupenyu hunoonekwa nevazhinji jawbone cavitation varwere, ingave zororo panzvimbo yekushanda kana kuderera kwechirwere chisingaperi kana chirwere kune imwe nzvimbo.

Tafura 5

Kuderedza (Red.) muRANTES / CCL5 muserum mu5 varwere vekenza yemazamu avo vakavhiyiwa nokuda kwemafuta-degenerative osteonecrosis yejawbone (FDOJ). Tafura yakagadziridzwa kubva

Lechner et al, 2021. Jawbone Cavitation Yakaratidzwa RANTES/CCL5: Nyaya Yenyaya Inobatanidza Kunyarara Kuzvimba muJawbone neEpistemology yeCancer yemazamu. Kenza Yezamu: Zvinangwa uye Kurapa.

Kurapa Modalities

Nekuda kwekushaikwa kwemabhuku ekurapa maronda emakumbo, IAOMT yakaongorora nhengo dzayo kuti iunganidze ruzivo maererano nemaitiro uye marapirwo ari kusimukira kusvika 'pamwero wekutarisira'. Migumisiro yeongororo inokurukurwa muchidimbu muAppendix II.

Kana imwe nguva nzvimbo uye ukuru hwezvironda zvakatemwa, nzira dzekurapa dzinodiwa. IAOMT ndeyepfungwa yekuti hazvigamuchirwi kusiya "pfupa rakafa" mumuviri wemunhu. Izvi zvinobva pane data rinoratidza kuti jawbone cavitations inogona kuve iyo foci ye systemic cytokines uye endotoxins kutanga maitiro ekudzikisira hutano hwese hwemurwere.

Mumamiriro ezvinhu akanaka, biopsy inofanira kuitwa kuti isimbise kuongororwa kweiyo chero chirwere cheshaya uye kubvisa dzimwe zvirwere. Zvadaro, kurapwa kwekubvisa kana kubvisa chirwere chinobatanidzwa uye kukurudzira kukura kwehutano hwakakosha hunodiwa. Panguva ino mumabhuku anotariswa nevezera rake, kurapa kwekuvhiya kunosanganisira kubvisa pfupa rakakanganisika risingakoshi kunoratidzika kunge ndiko kurapwa kunofarirwa kwemafupa eshaya. Kurapa kunosanganisira kushandiswa kweanesthetics yemunharaunda, izvo zvinotungamirira kukufungisisa kwakakosha. Zvaimbofungidzirwa kuti epinephrine ine anesthetics, iyo yave ichiziva vasoconstrictive properties, inofanira kudziviswa kune varwere vangave vatove vakanganisa kubuda kweropa kunobatanidza nemamiriro avo echirwere. Zvisinei, mune zvakatevedzana zvidzidzo zvema molecular, kusiyana kwe osteoblastic kwakawedzera nekushandiswa kwe epinephrine. Nokudaro, chiremba anofanira kusarudza pane imwe nyaya-ne-case kana kushandisa epinephrine uye kana zvakadaro, mari inofanira kushandiswa iyo ichapa migumisiro yakanakisisa.

Kutevera kurongedzerwa kwekuvhiya uye kunyatsogadziriswa kweronda uye kudiridza neine sterile yakajairika saline, kuporeswa kunowedzerwa nekuiswa kweplatelet-rich fibrin (PRF) magrafti mune osseous void. Kushandiswa kweplatelet-rich fibrin inotarisa mukuvhiya haisi kungobatsira chete kubva pakuona kwekuvhara, asiwo kubva kune chikamu chekusunungura zvinhu zvinokura mukati memazuva anosvika gumi nemana mushure mekuvhiyiwa. Pamberi pekushandiswa kwePRF grafts uye mamwe adjunctive therapies, kudzoka kwejawbone osteonecrotic lesion mushure mekuvhiyiwa kwakaitika mune dzakawanda se40% yezviitiko.

Kuongorora kwekunze kwengozi zvinhu zvinotsanangurwa muTable 2 zvinosimbisa kuti mhedzisiro isingafadzi inogona kudziviswa nemaitiro akakodzera ekuvhiya uye kusangana kwachiremba / murwere, kunyanya muhuwandu hwevanhu. Zvinokurudzirwa kufunga kutora nzira dzeatraumatic, kudzikisira kana kudzivirira periodontal uye zvimwe zvirwere zvemazino, uye kusarudza armamentarium iyo inobvumira kune yakanakisa kuporesa mhedzisiro. Kupa yakakwana pre- uye post-operative mirairo kumurwere, kusanganisira njodzi dzinosangana nekuputa fodya zvinogona kubatsira kuderedza mhedzisiro yakaipa.

Tichirangarira rondedzero yakafara yezvingangoitika zvengozi zvakanyorwa muTables 2 ne3, kubvunzana nemurwere akawedzera timu yekuchengeta inokurudzirwa kuti vaone nemazvo chero zvipi zvingave zvakavanzwa njodzi zvinogona kuita mukukura kwejawbone cavitations. Semuenzaniso, kukoshesa kwakakosha pakurapa jawbone cavitations ndeyekuti munhu ari kutora antidepressants, anosarudza serotonin reuptake inhibitors (SSRIs). SSRIs dzave dzichibatanidzwa nekuderedzwa kwefupa misa density uye yakawedzera kuputsika mitengo. Iyo SSRI Fluoxetine (Prozac) inodzivisa zvakananga osteoblast kusiyana uye mineralization. Zvidzidzo zviviri zvakazvimiririra zvinoongorora vashandisi veSSRI zvichienzaniswa nezvinodzora zvakaratidza kuti kushandiswa kweSRRI kwakabatana neakaipisisa panoramic morphometric indices.

Preconditioning inogonawo kubatsira kune zvakabudirira kurapwa mhedzisiro. Izvi zvinosanganisira kugadzira nharaunda yetishu inobatsira kupora nekupa muviri mazinga akakwana ezvikafu zvakakodzera izvo zvinovandudza iyo biological terrain nekugadzirisa homeostasis mumuviri. Mazano ekugadzirisa maitiro haasi nguva dzose anogoneka, kana anogamuchirwa kumurwere, asi anonyanya kukosha kune avo varwere vakaziva zvisizvo, zvakadai sevaya vane genetic predisposition, kuporesa zvirwere kana hutano hwakakanganisika. Mumamiriro ezvinhu akadaro, zvakakosha kuti optimization iyi iitike kuderedza mazinga eiyo oxidative kusagadzikana, izvo zvisingango kurudzira maitiro echirwere asi zvinogona kukanganisa kupora kwaunoda.

Sezvineiwo, kudzikiswa kwechero muchetura muviri wakaita se fluoride uye/kana mercury kubva kumazino amalgam kuzadzwa kunofanirwa kupedzwa kusati kwarapwa jawbone cavitations. Mercury inogona kubvisa simbi mucheni yekutakura erekitironi ye mitochondria. Izvi zvinoguma nekuwedzera kwesimbi yemahara (ferrous iron kana Fe ++), ichigadzira inokuvadza reactive oxygen marudzi (ROS) anozivikanwawo semahara radicals, ayo anokonzera oxidative kusagadzikana. Kuwedzerwa kwesimbi mumapfupa emapfupa kunodzivisawo kushanda kwakakodzera kweosteoblasts, iyo sezviri pachena ichava nemigumisiro yakaipa pakuedza kuporesa chirwere chemapfupa.

Zvimwe zvinokanganisa zvinofanirawo kugadziriswa vasati varapwa. Kana paine kushomeka kwebioavailable mhangura, magnesium uye retinol, metabolism uye kudzokororwa kwesimbi inova dysregulated mumuviri, izvo zvinokonzeresa kuwanda kwemahara iron munzvimbo dzisiridzo zvinotungamira kune yakanyanya oxidative kusagadzikana uye njodzi yechirwere. Kunyanya, ma enzymes akawanda ari mumuviri (akadai se ceruloplasmin) haashande kana pasina huwandu hwakakwana hwemhangura inowanika bioavailable, magnesium, uye retinol, izvo zvinozoita kuti systemic iron dysregulation ienderere mberi uye kuwedzera kweiyo oxidative kusagadzikana uye njodzi yechirwere.

Alternative Treatment Strategies

Dzimwe nzira dzinoshandiswa semurapi wekutanga kana kutsigira dzinofanirwa kuongororwawo. Izvi zvinosanganisira homeopathy, magetsi stimulation, light therapy senge photobiomodulation, uye laser, medical grade oxygen/ozone, hyperbaric oxygen, anticoagulation modalities, Sanum remedies, nutrition and nutraceuticals, infra-red sauna, intravenous ozone therapy, simba rekurapa, nezvimwewo. Panguva ino, sainzi haisati yaitwa yaizosimbisa idzi dzimwe nzira dzekurapa kuti dzinogona kushanda kana kusashanda. Maitiro ekutarisira kuti ave nechokwadi chekuporesa uye detoxification inofanira kusimbiswa. Matekiniki ekuongorora budiriro anofanirwa kuyedzwa nekumisikidzwa. Protocols kana nzira dzekubatsira kuona kana kurapwa kwakakodzera uye kana kusingafanirwe kuiswa kuti aongororwe.

CONCLUSIONS

Tsvagiridzo yakaratidza kuti kuvepo kwejawbone cavitations inzira inonyengera yechirwere inosanganiswa nekuderera kwekuyerera kweropa. Kukanganiswa kwemedullary kuyerera kweropa kunotungamirira kune isina kusimba mineralized uye kusakwana vascularization munzvimbo dzeshaya dzinogona kutapukirwa nehutachiona, kuwedzera kufa kwemasero. Ropa rine usimbe rinoyerera mukati me cavitational maronda anopokana nekuendeswa kwemishonga inorwisa mabhakitiriya, zvinovaka muviri uye vatumwa vanodzivirira zvirwere. Iyo ischemic nharaunda inogona zvakare kuchengetedza uye kukurudzira vasingaperi kuzvimba varevereri vanogona kunge vaine zvakatonyanya kukonzeresa hutano hwehutano. Genetic predisposition, kuderedzwa kwesimba rekudzivirira muviri, zvinokonzerwa nemimwe mishonga, kushungurudzika uye kutapukirwa, nezvimwe zvinhu zvakadai sekusvuta zvinogona kukurudzira kana kukurumidza kukura kweshaya.

Pamwe chete nemukurumbira wejawbone pathologist, Dr. Jerry Bouquot, iyo IAOMT iri kupa uye inokurudzira histologically uye pathologically yekuzivikanwa kwejawbone cavitational maronda seChronic Ischemic Medullary Disease yeJawbone, CIMDJ. Kunyange zvazvo mazita akawanda, acronyms, uye mazwi ane nhoroondo uye iye zvino ari kushandiswa kuratidza chirwere ichi, IAOMT inogutsikana kuti iyi ndiyo izwi rakakodzera rinotsanangura chirwere chepathologic uye micro-histologic inowanzowanikwa mujawbone cavitations.

Kunyange zvazvo maronda akawanda ejawbone cavitational ari kuoma kuongorora nemaitiro e-radiographs uye akawanda haasi anorwadza, munhu haafaniri kufunga kuti chirwere chacho hachipo. Kune maitiro akawanda ezvirwere zvakaoma kuongorora, uye mazhinji asingarwadzi. Kana tikashandisa marwadzo sechiratidzo chekurapa, chirwere cheperiodontal, chirwere cheshuga uye magomarara mazhinji angadai asina kurapwa. Nhasi chiremba wemazino ane zvakawanda zvakasiyana-siyana zvekugadzirisa zvinobudirira kubata jawbone cavitations uye kukundikana kubvuma chirwere uye kukurudzira kurapwa hakuna kuderera pane kutadza kuongorora uye kurapa periodontal chirwere. Kune hutano nekugara zvakanaka kwevarwere vedu, shanduko yeparadigm yakakosha kune vese vashandi vehutano, kusanganisira mazino uye vezvekurapa, ku1) kuziva kuwanda kwejawbone cavitations uye 2) kubvuma kubatana pakati pejawbone cavitations uye systemic chirwere.

MASHOKO OKUWEDZERA I

IAOMT SURVEY 2 RESULTS (2023)

Sezvakakurukurwa muchidimbu mupepa, mamiriro asina hukama anowanzo bvisa mushure mekuvhiyiwa kwecavitation. Kuti udzidze zvakawanda pamusoro pemhando dzipi dzemamiriro ekugadzirisa uye kuti kuregererwa kwepamusoro kunoitika sei maererano nekuvhiyiwa, ongororo yechipiri yakatumirwa kunhengo yeIAOMT. Rondedzero yezviratidzo nemamiriro ezvinhu ayo nhengo dzedare iri dzakacherekedza kuti zvivandudze pashure pokuvhiyiwa kwarongwa nokuda kweongororo. Vakapindura vakabvunzwa kana vakanga vaona chero yeaya mamiriro ekubvisa mushure mekuvhiyiwa, uye kana zvakadaro kusvika padanho ripi. Vakabvunzwawo kuti zviratidzo zvakakurumidza kubviswa here kana kuti kuvandudzwa kwacho kwakatora nguva yakareba kupfuura mwedzi miviri. Pamusoro pezvo, vakapindura vakabvunzwa kana vaiwanzovhiya panzvimbo dzega dzega, nzvimbo dzakawanda dzeunilateral, kana masaiti ese mukuvhiya kumwe chete. Migumisiro yeongororo inoratidzwa muFigure pazasi. Iyo data ndeyekutanga, zvichipihwa huwandu hwevakapindura hwaive hudiki (33) uye kuti pane imwe data isipo.

Appx I Fig 1 Vakapindura vakaronga nhanho yekuvandudza (zvinyoro, zvine mwero kana zvakakosha) uye vakacherekedza kana kuvandudzwa kwakaitika nekukurumidza (0-2 mwedzi) kana kutora nguva yakareba (> 2 mwedzi). Mamiriro ezvinhu/zviratidzo zvakanyorwa muhurongwa hwezvakawanda zvakashumwa. Ziva kuti mazhinji mamiriro/zviratidzo zvinoregererwa mukati memwedzi isingasviki miviri (kuruboshwe rwepakati).

Appx I Fig 2 Sezvinoratidzwa pamusoro apa, muzviitiko zvakawanda, Vamhan'ari havana kucherechedza nguva yekudzoka kwekuvandudzwa kwakaonekwa.

Appx I Fig 3 Vakapindura vakapindura mubvunzo, "Unowanzokurudzira/kuita

kuvhiyiwa kwemasaiti ega ega, nzvimbo dzeunilateral dzakarapwa pamwe chete, kana nzvimbo dzese dzakarapwa mukuvhiya kumwe chete?

MASHOKO OKUWEDZERA II

IAOMT SURVEY 1 RESULTS (2021)

Nekuda kwekushaikwa kwemabhuku uye kuongororwa kwekesi yekiriniki ine chekuita nekurapwa kwemaronda emudumbu, IAOMT yakaongorora nhengo yayo kuti iunganidze ruzivo maererano nemaitiro uye marapirwo ari kusimukira akananga 'kutarisirwa kwemaitiro'. Ongororo yakazara inowanikwa pawebhusaiti yeIAOMT (ona kuti havasi vese varapi vakapindura mibvunzo yese yeongororo).

Kupfupisa muchidimbu, ruzhinji rwevane 79 vakapindura vanopa kurapwa kwekuvhiya, uko kunosanganisira kupfava kwematishu kuratidzwa, kuvhiyiwa kwenzvimbo yecavitation, uye nzira dzakasiyana-siyana dzeku 'kuchenesa' mumuviri uye kuuraya hutachiona panzvimbo yakakanganiswa. Mishonga yakasiyana-siyana, nutraceuticals, uye / kana zvigadzirwa zveropa zvinoshandiswa kukurudzira kuporeswa kwechironda chisati chavhara ganda rakapfava.

Rotary burs inowanzoshandiswa kuvhura kana kuwana bony lesion. Vazhinji varapi vanoshandisa chiridzwa cheruoko kurapa kana kukwenya bhonzo rine chirwere (68%), asi mamwe maitiro nematurusi anoshandiswa, senge rotary bur (40%), piezoelectric (ultrasonic) chiridzwa (35%) kana ER: YAG laser (36%), iri laser frequency inoshandiswa kuyerera kwephotoacoustic.

Kana saiti yacho yacheneswa, yakasvibiswa, uye/kana kurapa, vazhinji vanopindura vanoshandisa ozone mvura/gasi kuuraya utachiona uye nekusimudzira kuporeswa. 86% yevakabvunzwa vanoshandisa PRF (platelet-rich fibrin), PRP (platelet-rich plasma) kana ozonated PRF kana PRP. Nzira inovimbisa yekuuraya utachiona yakataurwa muzvinyorwa uye mukati meongororo iyi (42%) ndiko kushandiswa kwe Er:YAG. 32% yevakabvunzurudzwa havashandisi chero rudzi rwepfupa kuzadza nzvimbo ye cavitation.

Vazhinji vakapindura (59%) havawanzo biopsy maronda vachitaura zvikonzero zvakasiyana kubva mumutengo, kusakwanisa kuwana masampula enyama anoshanda, kuomerwa nekutsvaga pathology lab, kana chokwadi chechimiro chechirwere.

Vazhinji vakapindura havashandisi mishonga inorwisa mabhakitiriya vasati vavhiyiwa (79%), panguva yekuvhiyiwa (95%) kana mushure mekuvhiya (69%). Imwe tsigiro yeIV inoshandiswa inosanganisira dexamethasone steroids (8%) uye maVitamin C (48%). Vazhinji vakapindura (52%) vanoshandisa yakaderera level laser therapy (LLLT) post inoshanda nechinangwa chekuporesa. Vazhinji vakapindura vanokurudzira rutsigiro rwezvekudya zvinosanganisira mavhitamini, zvicherwa, uye akasiyana homeopathics isati yasvika (81%) uye mukati (93%) nguva yekupora.

MASHOKO OKUWEDZERA III

Images

Appx III Fig 1 Kuruboshwe panhi: 2D X-ray diagnostics yenzvimbo #38. Peneru yekurudyi: Zvinyorwa zvenzvimbo yeFDO) munzvimbo yeretromolar 38/39 uchishandisa chinosiyanisa mushure mekuvhiyiwa kweFDOJ.

Mapeji: FDOJ, fatty degenerative osteonecrosis yeshaya.

Yakatorwa kubva kuLechner, et al, 2021. "Jawbone Cavitation Yakaratidzwa RANTES/CCL5: Nyaya Yenyaya Inobatanidza Kunyarara Kuzvimba muJawbone neEpistemology yeBreast Cancer." Kenza Yezamu: Zvinangwa uye Kurapa

Appx 3 Fig 2 Kuenzanisa kwema cytokines manomwe (FGF-2, IL-1ra, IL-6, IL-8, MCP-1, TNF-a uye RANTES) muFDOJ pasi pe RFT #47 nema cytokines mushaya ine utano (n = 19). Intraoperative zvinyorwa zvekuwedzera kweFDOJ murudyi rwezasi rushaya, nzvimbo #47 apically yeRFT #47, nemumiriri wekusiyanisa mushure mekuvhiya kubviswa kweRFT #47.

Mapeji: FDOJ, fatty degenerative osteonecrosis yeshaya.

Yakatorwa kubva kuLechner na von Baehr, 2015. "Chemokine RANTES / CCL5 seChibatanidzo Chisingazivikanwe pakati peKuporesa Kwemaronda muJawbone uye Systemic Disease: Is Prediction and Tailored Treatments in the Horizon?" Iyo EPMA Journal

Appx III Fig 3 Kuvhiya nzira ye retromolar BMDJ/FDOJ. Kuruboshwe panel: mushure mekupeta pasi mucoperiosteal flap, hwindo repfupa rakaumbwa mu cortex. Kurudyi pani: yakarapwa medullary cavity.

Abbreviations: BMDJ, chirema chepfupa mushaya; FDOJ, fatty degenerative osteonecrosis yeshaya.

Yakatorwa kubva kuLechner, et al, 2021. "Chisingaperi Kuneta Syndrome uye Bone Marrow Defects yeJaw - Nyaya Yenyaya Yekuwedzera Dental X-Ray Diagnostics neUltrasound." International Medical Case Reports Journal

Appx III Fig 4 (a) Curettage yeFDOJ mushaya yezasi ine denuded infra-alveolar nerve. (b) Inoenderana X-ray pasina chero zviratidzo zvepathological process mushaya.

Abbreviations: FDOJ, fatty degenerative osteonecrosis yeshaya

Yakagadziriswa kubva kuLechner, et al, 2015. "Peripheral Neuropathic Facial / Trigeminal Pain uye RANTES / CCL5 muJawbone Cavitation." Uchapupu-Hwakagadziridzwa Mamwe Mamwe Mishonga

Appx III Movie 1

Vhidhiyo clip (tinya kaviri pamufananidzo kuti uone clip) yekuvhiya shaya yeshaya inoratidza mafuta globules uye purulent kubuda kubva pashaya yemurwere aifungidzirwa kuti ane rushaya necrosis. Nekuda kwaDr. Miguel Stanley, DDS

Appx III Movie 2

Vhidhiyo clip (tinya kaviri pamufananidzo kuti uone clip) yekuvhiya shaya yeshaya inoratidza mafuta globules uye purulent kubuda kubva pashaya yemurwere aifungidzirwa kuti ane rushaya necrosis. Nekuda kwaDr. Miguel Stanley, DDS

Kuti udhaunirodhe kana kuprinda peji ino mumutauro wakasiyana, sarudza mutauro wako kubva pane yekudonhedza pasi iri kumusoro kuruboshwe kutanga.

IAOMT Position Pepa pane Human Jawbone Cavitations Vanyori