Ukulanda noma ukuphrinta leli khasi ngolimi oluhlukile, khetha ulimi lwakho kumenyu yokudonsela phansi phezulu kwesokunxele kuqala.

I-IAOMT Position Paper on Human Jawbone Cavitations

Usihlalo weKomidi Le-Jawbone Pathology: u-Ted Reese, DDS, MAGD, NMD, FIAOMT

U-Karl Anderson, DDS, MS, NMD, FIAOMT

Patricia Berube, DMD, MS, CFMD, FIAOMT

UJerry Bouquot, DDS, MSD

Teresa Franklin, PhD

Jack Kall, DMD, FAGD, MIAOMT

UCody Kriegel, DDS, NMD, FIAOMT

Sushma Lavu, DDS, FIAOMT

Tiffany Shields, DMD, NMD, FIAOMT

UMark Wisniewski, DDS, FIAOMT

Ikomidi lithanda ukuzwakalisa ukubonga kwethu kuMichael Gossweiler, DDS, MS, NMD, Miguel Stanley, DDS kanye noStuart Nunally, DDS, MS, FIAOMT, NMD ngokugxeka kwabo leli phepha. Sifisa futhi ukubonga amagalelo nomzamo omkhulu owenziwa uDkt. Nunnally ekuhlanganiseni iphepha lesikhundla sika-2014. Umsebenzi wakhe, ukukhuthala kanye nokwenza kwakhe kunikeze umgogodla waleli phepha elibuyekeziwe.

Kugunyazwe Ibhodi Labaqondisi le-IAOMT Septhemba 2023

Okuqukethwe

Isingeniso

Umlando

Sifo

I-cone beam computed tomography (CBCT)

ultrasound

Ama-Biomarker kanye nokuhlolwa kwe-Histological

Ukucatshangelwa okuvelayo ngezinjongo zokuxilonga

I-Thermography

I-Acupuncture Meridian Assessment

Izingozi Zezingozi

Imiphumela Yesistimu Nemitholampilo

Izindlela Zokwelapha

Amanye Amasu Okwelapha

iziphetho

Okubhekwayo

Isithasiselo I I-IAOMT Survey 2 Imiphumela

Isithasiselo II I-IAOMT Survey 1 Imiphumela

Isithasiselo III Izithombe

Umfanekiso 1 I-fatty degenerative osteonecrosis yomhlathi (FDOJ)

Umfanekiso we-2 Cytokines ku-FDOJ uma uqhathaniswa nezilawuli ezinempilo

Umfanekiso 3 Inqubo yokuhlinzwa ye-retromolar FDOJ

Umfanekiso 4 I-Curettage kanye ne-x-ray ehambisanayo ye-FDOJ

Amamuvi Iziqeshana zevidiyo zokuhlinzwa komhlathi ezigulini

ISINGENISO

Kule minyaka eyishumi edlule kube nokuqwashisa okwandayo phakathi komphakathi nabahlinzeki bezempilo mayelana nokuxhumana phakathi kwempilo yomlomo kanye nesistimu . Isibonelo, isifo se-periodontal siyingozi kokubili isifo sikashukela nesifo senhliziyo . Isixhumanisi esingase sibe umphumela futhi esicwaningwa ngokwandayo siphinde saboniswa phakathi kokugula kwethambo lomhlathi kanye nempilo ephelele namandla omuntu . Ukusetshenziswa kwezindlela zokuthwebula ezithuthuke ngobuchwepheshe ezifana ne-cone-beam computed tomography (CBCT) kube usizo olukhulu ekuhlonzeni izifo zethambo lomhlathi, okuye kwaholela ekuthuthukisweni kwamakhono okuxilonga kanye nekhono elithuthukisiwe lokuhlola impumelelo yokungenelela kokuhlinzwa . Imibiko yesayensi, ama-docudramas kanye nemithombo yezokuxhumana iye yandisa ukuqwashisa komphakathi ngalawa ma-pathologies, ikakhulukazi phakathi kwalabo bantu abaphethwe yizimo ezingapheli zemizwa noma zesistimu ezihlulekayo ukuphendula ekungeneleleni kwendabuko kwezokwelapha noma kwamazinyo.

I-International Academy of Oral Medicine and Toxicology (IAOMT) isekelwe enkolelweni yokuthi isayensi kufanele ibe yisisekelo lapho zonke izindlela zokuxilonga nezokwelashwa zikhethwa futhi zisetshenziswe khona. Kungenxa yalokhu kuqala engqondweni ukuthi thina 1) sinikeza lesi sibuyekezo ku-2014 IAOMT Jawbone Osteonecrosis Position Paper yethu, kanye ne-2) siphakamisa, ngokusekelwe ekuqaphelisweni kwe-histological, igama elinembile ngokwesayensi nezokwelapha lesi sifo, ikakhulukazi, I-Chronic Ischemic Medullary Disease. Yomhlathi (CIMDJ). I-CIMDJ ichaza isimo sethambo esibonakala ngokufa kwezingxenye zeselula zethambo elikhansela, okulandela ukuphazamiseka kokunikezwa kwegazi . Kuwo wonke umlando wayo, lokhu esibhekisela kukho njenge-CIMDJ kubhekiselwe kukho inqwaba yamagama nama-akhronimi asohlwini lweThebula 1 futhi kuzoxoxwa kafushane ngezansi.

Umgomo kanye nenhloso yalesi Academy kanye nephepha ukuhlinzeka ngesayensi, ucwaningo, nokubhekwa komtholampilo ezigulini nabahlengikazi ukuze benze izinqumo ezinolwazi lapho becubungula lezi zilonda ze-CIMDJ, ezivame ukubizwa ngokuthi i-jawbone cavitations. Leli phepha lango-2023 laklanywa ngomzamo ohlanganyelwe ohlanganisa odokotela, abacwaningi kanye nodokotela ovelele wezifo zethambo lomhlathi, uDkt. Jerry Bouquot, ngemva kokubuyekezwa kwezindatshana ezingaphezu kuka-270.

UMLANDO

Alikho elinye ithambo amandla okuhlukumezeka nokungenwa izifo ezinkulu njengasemihlathini. Ukubuyekezwa kwezincwadi eziphathelene nesihloko se-jawbone cavitations, (okungukuthi, i-CIMDJ) kukhombisa ukuthi lesi simo sitholwe, selashwa futhi sacwaningwa kusukela ngawo-1860. Ngo-1867, uDkt. HR Noel wanikeza inkulumo enesihloko esithi Isifundo nge-caries ne-necrosis yamathambo e-Baltimore College of Dental Surgery, futhi ngo-1901 ama-jawbone cavitations axoxwa kabanzi nguWilliam C. Barrett encwadini yakhe enesihloko esithi, I-Oral Pathology and Practice: Incwadi Yokusetshenziswa Kwabafundi Emakolishi Amazinyo kanye Nencwadi Yabasebenzi Bamazinyo. U-GV Black, ovame ukubizwa ngokuthi uyise wodokotela bamazinyo besimanje, wahlanganisa nengxenye encwadini yakhe yokufunda yango-1915, i-Special Dental Pathology, ukuchaza 'ukubukeka nokwelashwa okuvamile' lokho akuchaza ngokuthi i-jawbone osteonecrosis (JON) .

Ucwaningo lwama-jawbone cavitations lwabonakala luma kwaze kwaba ngawo-1970 lapho abanye beqala ukucwaninga ngesihloko, besebenzisa amagama namalebula anhlobonhlobo, futhi beshicilela ukwaziswa okuphathelene nakho ezincwadini zesimanje ze-oral pathology. Isibonelo, ku-1992 u-Bouquot et al wabona ukuvuvukala kwe-intraosseous ezigulini ezinezinhlungu ezingapheli futhi ezinzima ebusweni (N = 135) futhi waqamba igama elithi 'Neuralgia-inducing Cavitational Osteonecrosis', noma i-NICO. Nakuba u-Bouquot et al engazange aphawule nge-etiology yalesi sifo, baphetha ngokuthi kungenzeka ukuthi izilonda zenze i-neuralgia yobuso engapheli enezici zendawo eziyingqayizivele: ukwakheka kwe-intraosseous cavity kanye necrosis yamathambo ehlala isikhathi eside ngokuphulukiswa okuncane. Ocwaningweni lomtholampilo lweziguli ezine-trigeminal (N = 38) ne-facial (N = 33) neuralgia, u-Ratner et al, uphinde wabonisa ukuthi cishe zonke iziguli zinezimbobo ethanjeni le-alveolar nomhlathi. Imigodi, ngezinye izikhathi engaphezu kwesentimitha elingu-1 ububanzi, yayisezindaweni zokukhishwa kwamazinyo kwangaphambilini futhi ngokuvamile yayingabonwa ngama-x ray.

Izinhlobonhlobo zamanye amatemu alokho esikukhomba njenge-CIMDJ akhona ezincwadini. Lokhu kubalwe kuThebula 1 futhi kuxoxwe kafushane lapha. U-Adams et al baqambe igama elithi Chronic Fibrosing Osteomyelitis (CFO) ephepheni lesimo sango-2014. Iphepha lesikhundla libe ngumphumela wenhlangano ehlukahlukene yodokotela abavela emikhakheni ye-Oral Medicine, Endodontics, Oral Pathology, Neurology, Rheumatology, Otolaryngology, Periodontology, Psychiatry, Oral and Maxillofacial Radiology, Anesthesia, General Dentistry, Internal Medicine, kanye nokwelapha kwangaphakathi. . Iqembu beligxile ekuhlinzekeni inkundla yezinhlaka ezahlukene ukwelapha izifo ezihambisana nekhanda, intamo, nobuso. Ngemizamo ehlangene yaleli qembu, ukusesha kwezincwadi okunabile kanye nezingxoxo neziguli, kwavela iphethini yomtholampilo ehlukile, abayibiza ngokuthi yi-CFO. Baphawule ukuthi lesi sifo ngokuvamile asitholakali ngenxa yokugula kwaso nezinye izimo zesistimu. Leli qembu laveza ukuxhumana okungase kube khona phakathi kwesifo kanye nezindaba zezempilo ezihlelekile kanye nesidingo sethimba lodokotela ukuze lixilonge futhi lelaphe isiguli ngendlela efanele .

Izilonda ze-jawbone cavitational nazo ziye zabonwa ezinganeni. Ngo-2013, u-Obel et al wachaza izilonda ezinganeni futhi waqamba igama elithi Juvenile Mandibular Chronic Osteomyelitis (JMCO). Leli qembu liphakamise ukusetshenziswa okungenzeka kwe-intravenous (IV) bisphosphonates njengokwelashwa kwalezi zingane. Ngo-2016 u-Padwa et al washicilela ucwaningo oluchaza i-focal sterile inflammatory osteitis emathanjeni omhlathi eziguli. Babhale isilonda se-Pediatric Chronic Nonbacterial Osteomyelitis (CNO).

Kusukela ngo-2010, uDkt. Johann Lechner, umbhali oshicilelwe kakhulu kanye nomcwaningi wezilonda ze-jawbone cavitational, nabanye baye bacwaninga ubuhlobo balezi zilonda ekukhiqizeni i-cytokine, ikakhulukazi i-cytokine evuthayo RANTES (eyaziwa nangokuthi i-CCL5). UDkt. Lechner usebenzise amagama ahlukahlukene ukuchaza lezi zilonda ezifake i-NICO eshiwo ngaphambili kodwa futhi i-Aseptic Ischemic Osteonecrosis kuJawbone (AIOJ), kanye ne-Fatty Degenerative Osteonecrosis yomhlathi (FDOJ) . Incazelo/ilebula yakhe isekelwe ekubukekeni komzimba kanye/noma isimo se-macroscopically pathological esiqashelwa ngomtholampilo noma ngokuhlinzwa.

Manje kunesidingo sokucacisa enye i-pathosis yethambo lomhlathi esanda kuhlonzwa ehlukile esihlokweni saleli phepha kodwa engase idide kulabo abenza ucwaningo lwezilonda ze-cavitational. Lezi yizilonda zamathambo emhlathini ezivela ngenxa yokusetshenziswa kwemithi. Izilonda zibonakala kahle kakhulu ngokulahleka kwegazi okulandela ukulandelwa okungalawuleki kwethambo. Lezi zilonda zibizwe ngokuthi i-Oral Ulceration with Bone Sequestration (OUBS) nguRuggiero et al ephepheni le-position for I-American Association of Oral and Maxillofacial Surgeons (AAOMS), kanye noPalla et al, ekubuyekezweni okuhlelekile . Njengoba le nkinga ihlobene nokusetshenziswa kwemithi eyodwa noma eminingi, i-IAOMT iwumqondo wokuthi lolu hlobo lwesilonda luchazwa kangcono ngokuthi i-Osteonecrosis yomhlathi ehlobene nemithi (MRONJ). I-MRONJ ngeke kuxoxwe ngayo kuleli phepha njengoba i-etiology yayo kanye nezindlela zokwelashwa zihlukile kulena esiyibiza ngokuthi i-CIMDJ, futhi iye yacwaningwa kabanzi ngaphambilini .

UKUHLOLA

Ukusetshenziswa okuvamile kwe-Cone-beam computed tomography (CBCT) radiographs ngodokotela abaningi bamazinyo kuye kwaholela ekwenyukeni kokugcinwa kwama-intramedullary cavitations esiwabiza ngokuthi yi-CIMDJ, futhi ayenganakwa ngaphambilini futhi yingakho enganakwa. Manje njengoba lezi zilonda neziphazamiso sezibonakala kalula, kuba yisibopho somsebenzi wamazinyo ukuxilonga lesi sifo futhi unikeze izincomo zokwelashwa nokunakekelwa.

Ukwazisa nokuhlonza ubukhona be-CIMDJ kuyisiqalo sokuyiqonda. Kungakhathaliseki ukuthi amagama amaningi nama-acronyms ahlotshaniswa nesifo, ukuba khona kwe-necrotic, noma ithambo elifayo engxenyeni ye-medullary yomhlathi kutholakale kahle .

Uma kubukwa ngesikhathi sokuhlinzwa lezi ziphambeko zamathambo zizibonakalisa ngezindlela eziningi. Abanye odokotela babika ukuthi izilonda ezingaphezu kuka-75% ziyizigodi ngokuphelele noma zigcwele izicubu ezithambile, ezimpunga ngokumpunga kanye nezinamaminerali/granulomatis, ngokuvamile okunamafutha aphuzi (ama-cysts kawoyela) atholakala ezindaweni ezinokukhubazeka ezinokwakheka kwamathambo azungezile. Abanye babika ukuba khona kwama-cavitations ane-cortical bone density eyedlulele ehlukahlukene okuthi lapho evuleka, abonakale enamalayini anemicu emnyama, ensundu noma empunga. Kanti abanye babika izinguquko ezimbi ngendlela ehlukahlukene ezichazwa ngokuthi “i-gritty”, “like sawdust”, “imigodi engenalutho”, “nokoma” okunokuqina okuqinile okunjengezinyo ngezikhathi ezithile. Ekuhlolweni kwe-histological, lezi zilonda zibonakala zifana ne-necrosis eyenzeka kwamanye amathambo omzimba futhi i-histologically ihluke ku-osteomyelitis (Bheka Umfanekiso 1). Izithombe ezengeziwe ezibonisa isifo se-CIMDJ, ezinye eziyingcaca ngokwemvelo, zifakwe ku-Appendix III ekupheleni kwalo mbhalo.

Umfanekiso we-1 Izithombe ze-CIMDJ ezithathwe ku-cadaver

Njengabanye odokotela bezempilo, odokotela bamazinyo basebenzisa inqubo ehlelekile esebenzisa izindlela nezindlela ezahlukahlukene ukuxilonga izilonda ze-cavitational. Lokhu kungase kuhlanganise ukwenza ukuhlola ngokomzimba okuhlanganisa ukuthatha umlando wezempilo, ukuhlola izimpawu, ukuthola uketshezi lomzimba ukuze kwenziwe izivivinyo zaselabhorethri, nokuthola amasampula ezicubu ze-biopsy kanye nokuhlolwa kwe-microbiological (okungukuthi, ukuhlola ukuba khona kwamagciwane). Ubuchwepheshe bezithombe, obufana ne-CBCT buvame ukusetshenziswa . Ezigulini ezinezinkinga eziyinkimbinkimbi ezingahlali zilandela iphethini noma zilingane nokuhlelwa okujwayelekile kwezimpawu eziyinkimbinkimbi, inqubo yokuxilonga ingadinga ukuhlaziya okunemininingwane eyengeziwe okungase kuqala kuphumele ekuxilongweni okuhlukile. Izincazelo ezimfushane zeziningi zalezi zindlela zokuxilonga zinikezwe ngezansi.

I-cone beam computed tomography (CBCT)

Izindlela zokuxilonga ezichazwe ekuqaleni kuka-1979 ngu-Ratner nozakwabo, kusetshenziswa i-digital palpation nezingcindezi, imijovo yokuxilonga yendawo yokubulala izinzwa, ukucatshangelwa komlando wezokwelapha kanye nendawo yobuhlungu obukhiphayo kuyasiza ekuxilongeni i-jawbone cavitations. Nokho, nakuba ezinye zalezi zilonda zibangela ubuhlungu, ukuvuvukala, ububomvu ngisho nomkhuhlane, ezinye azikwenzi. Ngakho-ke, isilinganiso esinenjongo, njengokuthatha izithombe ngokuvamile siyadingeka.

Ama-Cavitations awavami ukutholwa kumafilimu eradiyographic ajwayelekile anohlangothi olubili (2-D) asetshenziswa kakhulu kudokotela wamazinyo. U-Ratner kanye nozakwabo baye babonisa ukuthi i-40% noma ngaphezulu kwethambo idinga ukuguqulwa ukuze kuboniswe izinguquko, futhi lokhu kusekelwa umsebenzi wakamuva, futhi kuboniswe kuMfanekiso 2. Lokhu kuhlobene nomkhawulo wemvelo we-imaging ye-2-D ebangela ukuphakama okuphezulu. yezakhiwo ze-anatomical, izindawo zokufihla isithakazelo. Esimeni sokukhubazeka noma i-pathology, ikakhulukazi ku-mandible, umphumela wokuvala wethambo lekhohlo elicinene ezakhiweni ezingaphansi ungaba obalulekile . Ngakho-ke, izindlela zokuthwebula ezithuthuke kakhulu kubuchwepheshe ezifana ne-CBCT, izikena ze-Tech 99, imaging resonance magnetic (MRI), noma i-trans-alveolar ultrasound sonography (CaviTAU™®) ziyadingeka .

Kumasu ahlukahlukene wokucabanga atholakalayo, i-CBCT iyithuluzi lokuxilonga elisetshenziswa kakhulu elisetshenziswa odokotela bamazinyo abathintekayo ekuxilongeni noma ekwelapheni ama-cavitations, ngakho-ke leyo esizoxoxa ngayo ngokujulile. Isisekelo sobuchwepheshe be-CBCT yikhono layo lokubuka i-lesion of interest in 3 dimensions (frontal, sagittal, coronal). I-CBCT ibonakale iyindlela enokwethenjelwa nenembile yokuhlonza nokulinganisa ubukhulu kanye nezinga lokukhubazeka kwangaphakathi kwamathambo emhlathini ngokuhlanekezela okuncane nokukhuliswa okuncane kune-x-ray engu-2-D.

Umfanekiso we-2 Amazwibela: Ngakwesobunxele kukhonjiswa ama-radiograph angu-2-D amathambo omhlathi athathwe kuma-cadaver avelayo.

enempilo. Ngakwesokudla somfanekiso kunezithombe zemihlathi efanayo ekhombisa i-necrotic cavitation esobala.

Umfanekiso uthathwe ku-Bouquot, 2014.

Ucwaningo lwezokwelapha luye lwabonisa izithombe ze-CBCT futhi ziyasiza ekunqumeni okuqukethwe kwesilonda (okugcwele uketshezi, i-granulomatous, okuqinile, njll.), okungenzeka kusize ukuhlukanisa phakathi kwezilonda ezivuthayo, i-odontogenic noma i-non-odontogenic tumors, ama-cysts, nezinye i-benign noma ezimbi. izilonda .

Isofthiwe esanda kwakhiwa ehlanganiswe ngokukhethekile nezinhlobo ezahlukene zamadivayisi e-CBCT isebenzisa amayunithi e-Hounsfield (HU) avumela ukuhlolwa okulinganiselwe kokuminyana kwamathambo . I-HU imele ukuminyana okuhlobene kwezicubu zomzimba ngokwesilinganiso esilinganiselwe sezinga elimpunga, ngokusekelwe kumanani omoya (-1000 HU), amanzi (0 HU), nokuminyana kwamathambo (+1000 HU). Umfanekiso 3 ubonisa imibono ehlukene yesithombe sesimanje se-CBCT.

Ukufingqa, i-CBCT ifakazele ukuthi ilusizo ekuxilongeni nasekwelapheni i-jawbone cavitations ngokuthi:

1. Ukuhlonza ubukhulu, ububanzi kanye nokuma okungu-3-D kwesilonda;
2. Ukuhlonza ukusondela kwesilonda kwezinye izakhiwo ezibalulekile ze-anatomical eziseduze njenge-

i-alveolar nerve engaphansi, i-maxillary sinus, noma izimpande zamazinyo eziseduze;

1. Ukunquma indlela yokwelapha: ukuhlinzwa ngokumelene nokungahlinzeki; futhi
2. Ukuhlinzeka ngesithombe sokulandelela ukuze kunqunywe izinga lokuphulukisa kanye nesidingo esingaba khona

ukwelapha kabusha isilonda.

Umfanekiso we-3 Ukucaca okuthuthukisiwe kwesithombe se-CBCT ngenxa yobuchwepheshe besofthiwe ecwengisisiwe, enciphisa ama-artifact kanye "nomsindo" okufakelwa kwamazinyo nokubuyiselwa kwensimbi okungase kubangele esithombeni. Lokhu kuvumela udokotela wamazinyo nesiguli ukuba babone isilonda kalula. Iphaneli ephezulu iwukubuka kwe-panoramic kwe-CBCT ebonisa indawo yesobunxele (#17) kanye nesokudla (#32) kanye nobukhulu bezilonda ze-cavitational esigulini se-hawbone osteonecrosis. Iphaneli elingezansi kwesokunxele liwukubuka okune-sagital kwesayithi ngalinye. Iphaneli engezansi kwesokudla iwukunikezwa kwe-3-D kwesayithi #17 okubonisa i-cortical porosity overlying medullary cavitation. Ngenhlonipho kaDkt. Reese.

ultrasound

Siphinde sisho kafushane lapha ngedivayisi ye-ultrasound, i-CaviTAU™®, ethuthukisiwe futhi esetshenziswa ezingxenyeni ezithile ze-Europe, ikakhulukazi ukuthola izindawo eziphansi zamathambo emihlathi engenhla nangaphansi ephakamisa ukuguquguquka kwethambo lomhlathi. Le divayisi ye-trans-alveolar ultrasonic sonography (TAU-n) ingase ilingane uma iqhathaniswa ne-CBCT ekutholeni ukukhubazeka komnkantsha, futhi inenzuzo eyengeziwe yokuchaya isiguli emazingeni aphansi kakhulu emisebe . Le divayisi okwamanje ayitholakali e-US kodwa ingaphansi kokubuyekezwa yi-US Food and Drug Administration futhi ingaba ithuluzi eliyinhloko lokuxilonga elisetshenziswa eNyakatho Melika ukwelapha i-CIMJD.

Ama-Biomarker kanye nokuhlolwa kwe-Histological

Ngenxa yemvelo yokuvuvukala kwe-jawbone cavitations u-Lechner no-Baehr, i-2017 baye baphenya ubudlelwano obukhona phakathi kwama-cytokines akhethiwe kanye nesifo. I-cytokine eyodwa ethakaselwayo ethile 'ilawulwa lapho iqalisa ukusebenza, i-T-cell evamile evezwayo futhi iyimfihlo' (RANTES). Le cytokine, kanye ne-fibroblast growth factor (FGF) -2, iboniswa ngamanani amakhulu ezilonda ze-cavitational kanye neziguli ezine-CIMDJ. Umfanekiso we-4, onikezwe uDkt. Lechner, uqhathanisa amazinga we-RANTES ezigulini ezine-cavitations (ibha ebomvu, kwesokunxele) namazinga okulawula okunempilo (ibha eluhlaza okwesibhakabhaka), ebonisa amazinga angaphezu kwezikhathi ze-25 ezinkulu kulabo abanesifo. U-Lechner et al usebenzisa izindlela ezimbili zokukala amazinga e-cytokine. Enye iwukukala amazinga e-cytokines ngokwesistimu egazini (I-Diagnostic Solutions Laboratory, e-US.). Indlela yesibili ukuthatha i-biopsy ngqo endaweni enesifo lapho ifinyelelwa ukuze ihlolwe udokotela ohlola izifo ngomlomo. Ngeshwa, ngalesi sikhathi amasampula ezicubu zendawo adinga ukucutshungulwa okuyinkimbinkimbi nokuthunyelwa okusazozuzwa ezindaweni ezingacwaningi, kodwa kunikeze ukuhlobana okunokuqonda.

Umfanekiso we-4 Ukusatshalaliswa kwe-RANTES kumakesi angu-31 e-FDOJ namasampuli angu-19 omhlathi ovamile ngokuqhathaniswa nereferensi ye-x-ray yokuminyana kwawo womabili amaqembu ezindaweni ezihambisanayo. Izifinyezo: I-RANTES, elawulwa lapho iqala ukusebenza, i-T-cell evamile evezwa futhi eyimfihlo ye-chemokine (CC motif) ligand 5; XrDn, X-ray ukuminyana; I-FDOJ, i-fatty degenerative osteonecrosis yomhlathi; n, inombolo; Ctrl, lawula. Umfanekiso unikezwe uDkt. Lechner. Inombolo yelayisensi: CC BY-NC 3.0

Ukucatshangelwa okuvelayo ngezinjongo zokuxilonga

Ukuba khona kwe-jawbone cavitations kuye kwasungulwa kahle emtholampilo. Kodwa-ke, ukuxilonga okucacile kanye nemingcele yokwelashwa okuhamba phambili kudinga ucwaningo olwengeziwe. Unalokho emqondweni kuyadingeka ukubalula kafushane amasu ambalwa athakazelisayo nangase abe wusizo asetshenziswa abanye odokotela.

I-Thermography

Kuyaqashelwa ukuthi ukuhlolwa okwengeziwe kwe-physiologic kungaba ithuluzi elibalulekile lokuhlola nokuxilonga. Elinye ithuluzi elinjalo elisetshenziswa abanye odokotela i-thermographic imaging. Umsebenzi wokuvuvukala ojwayelekile ungabonakala ngokulinganisa ukuhluka kokushisa ebusweni bekhanda nentamo. I-Thermography iphephile, iyashesha futhi ingaba nenani lokuxilonga elifana nele-CBCT. I-drawback ephawulekayo ukuthi ayinayo incazelo, okwenza kube nzima ukubona umkhawulo noma ubukhulu besilonda.

I-Acupuncture Meridian Assessment

Abanye odokotela babheka iphrofayili enamandla yesilonda esisebenzisa i-Acupuncture Meridian Assessment (AMA) ukuze banqume umthelela wayo ku-meridian yamandla ehambisanayo. Lolu hlobo lokuhlola lusekelwe ku-Electroacupuncture Ngokusho kweVoll (EAV) . Le nqubo, esekelwe emithini yasendulo yamaShayina kanye nezimiso zokutshopa, iye yathuthukiswa futhi iyafundiswa e-US. I-acupuncture isetshenziselwe ukudambisa izinhlungu futhi ikhuthaze ukuphulukiswa. Isekelwe ekulinganiseni kokugeleza kwamandla (okungukuthi, i-Chi) ngokusebenzisa izindlela ezithile zamandla emzimbeni. Lezi zindlela, noma ama-meridians, zixhuma izitho ezithile, izicubu, imisipha namathambo komunye nomunye. I-acupuncture isebenzisa amaphuzu acacile ku-meridian ukuze ibe nomthelela empilweni namandla azo zonke izakhi zomzimba kuleyo meridian. Le nqubo iye yasetshenziswa ukuze kwembule isifo somhlathi, okuthi lapho sixazululwa, futhi selaphe izifo ezibonakala zingahlobene, njengesifo sokuqaqamba kwamalunga noma isifo sokukhathala esingamahlalakhona. Le nqubo isiza ekuqhubekiseni uphenyo (okungukuthi, imiphumela idinga ukubhalwa futhi kutholwe idatha yobude futhi isatshalaliswe).

Amaqiniso

Kunezici eziningi zomuntu ngamunye ezandisa ubungozi bokuthuthukiswa kwe-jawbone cavitations kodwa ngokuvamile ingozi i-multifactorial. Izingozi kumuntu ngamunye zingaba amathonya angaphandle, njengezici zemvelo noma imithelela yangaphakathi, njengokungasebenzi kahle kwamasosha omzimba. Amathebula 2 no-3 aklelisa izici eziyingozi zangaphandle nezangaphakathi.

Qaphela ukuthi Ithebula lesi-2, I-Internal Risk Factors, ayifaki i-genetic predisposition. Nakuba ukuhlukahluka kofuzo kungacatshangwa ukuthi kunendima, akukho ukuhluka kwesakhi sofuzo esisodwa noma inhlanganisela yezakhi zofuzo okuye kwabonakala kuhlonzwa njengengozi, nokho amathonya ofuzo kungenzeka. . Ukubuyekezwa okuhlelekile kwezincwadi okwenziwa ngo-2019 kubonise ukuthi kukhonjwe inani le-nucleotide polymorphisms eyodwa, kepha akukho ukuphindaphinda kuzo zonke izifundo. Ababhali baphetha ngokuthi uma kubhekwa ukuhlukahluka kwezakhi zofuzo eziye zabonisa izinhlangano ezinhle nama-cavitations kanye nokuntuleka kokuphindaphinda kwezifundo, indima edlalwa yizimbangela zofuzo izobonakala ilinganiselwe futhi ihluke kakhulu. Kodwa-ke, ukukhomba abantu abathile kungase kudingeke ukuze kubonakale umehluko wofuzo . Ngempela, njengoba kubonisiwe, enye yezindlela ezivame kakhulu futhi eziyisisekelo ze-pathophysiologic zokulimala kwethambo le-ischemic i-clotting ngokweqile kusuka ezifundeni ze-hypercoagulation, ezivame ukuba ne-genetic underpinnings, njengoba kuchazwe ngu-Bouquot no-Lamarche (1999) . Ithebula lesi-4 elinikezwe uDkt. Bouquot, libala lesi sifo sithi sibandakanya i-hypercoagulation futhi izigaba ezilandelayo ze-3 zinikeza umbono wezinye zezinto ezitholwe nguDkt.

Emigodini ye-jawbone kunobufakazi obucacile be-ischemic osteonecrosis, okuyisifo somongo wethambo lapho ithambo liba necrotic ngenxa yokuntuleka kwe-oxygen kanye nezakhi zomzimba. Njengoba kushiwo, izici eziningi zingasebenzisana ukuze zikhiqize ama-cavitations futhi kufika ku-80% weziguli zinenkinga, ngokuvamile ezuzwe njengefa, yokukhiqizwa ngokweqile kwamahlule egazi emithanjeni yazo yegazi. Lesi sifo ngokuvamile asivezwa ngesikhathi sokuhlolwa kwegazi okujwayelekile. Ithambo lithinteka ikakhulukazi kule nkinga ye-hypercoagulation futhi ikhula kakhulu imithambo yegazi; ukwanda, ngokuvamile kubuhlungu, izingcindezi zangaphakathi; ukugqwala kwegazi; ngisho nama-infarction. Le nkinga ye-hypercoagulation ingase iphakanyiswe umlando womndeni we-stroke nesifo senhliziyo esemncane (engaphansi kweminyaka engu-55), ukubuyisela inqulu noma "arthritis" (ikakhulukazi esemncane), i-osteonecrosis (ikakhulukazi esemncane), ejulile. i-vein thrombosis, i-pulmonary emboli (amahlule egazi emaphashini), i-retinal vein thrombosis (amahlule ku-retina yeso) nokuphuphuma kwesisu okuphindaphindiwe. Imihlathi inezinkinga ezithize ezi-2 ngalesi sifo: 1) uma isilimele, ithambo eligulayo alikwazi ukumelana nezifo ezisezingeni eliphansi ezivela kumagciwane ezinyo nezinsini; futhi 2) ithambo lingase lingalulami ekugelezeni kwegazi okunciphile okubangelwa izibulala-zinzwa zendawo ezisetshenziswa odokotela bamazinyo phakathi nomsebenzi wamazinyo. Umfanekiso wesi-5 unikeza umbono we-microscopic we-thrombus ye-intravascular.

Ithebula 4 Izifo ezibangelwa yi-hypercoagulation. Iziguli ezine kweziyisihlanu ze-jawbone cavitation zinenye yalezi zihlule

izinkinga zesici.

Kungakhathaliseki ukuthi iyini imbangela eyinhloko ye-hypercoagulation, ithambo liba nomnkantsha we-fibrous (imicu ingahlala ezindaweni ezilambile), umnkantsha onamafutha, ofile ("ukubola okumanzi"), umnkantsha owomile kakhulu, ngezinye izikhathi wesikhumba ("ukubola okomile" ), noma isikhala somongo esingenalutho (“cavitation”).

Noma yiliphi ithambo lingathinteka, kodwa izinqe, amadolo nemihlathi kuvame ukubandakanyeka. Ubuhlungu buvame ukuba nzima kodwa cishe 1/3^rd weziguli azizwa ubuhlungu. Umzimba unenkinga yokuzelapha kulesi sifo kanye no-2/3^izindundla izimo zidinga ukukhishwa ngokuhlinzwa komnkantsha owonakele, ngokuvamile ngokuklwebha ngama-curettes. Ukuhlinzwa kuzoqeda inkinga (kanye nobuhlungu) cishe ku-3/4^ths kweziguli ezithinteka emhlathini, nakuba ukuhlinzwa okuphindaphindiwe, ngokuvamile izinqubo ezincane kunezokuqala, ziyadingeka ku-40% weziguli, ngezinye izikhathi kwezinye izingxenye zemihlathi, ngoba lesi sifo sivame ukuba nezilonda "zeqa" (okungukuthi, izindawo eziningi endaweni amathambo afanayo noma afanayo), nomnkantsha ovamile phakathi. Iziguli ezingaphezu kwengxenye ye-hip ekugcineni zizothola lesi sifo ku-hip ehlukile. Ngaphezu kwe-1/3^rd iziguli zemihlathi zizothola lesi sifo kwamanye amaquadrants omhlathi. Muva nje, kutholwe ukuthi i-40% yeziguli ezine-osteonecrosis ye-hip noma yomhlathi zizophendula i-anticoagulation nge-heparin ephansi ye-molecular weight (Lovenox) noma i-Coumadin ngokuxazulula ubuhlungu kanye nokuphulukiswa kwamathambo.

Umfanekiso we-5 Ukubuka okuncane kwe-intravascular thrombi

Uma ifuna indlela engeyona eyemithi yokwehlisa ingcuphe ye-hypercoagulation umuntu angacabangela ukusetshenziswa kwama-enzyme engeziwe njenge-nattokinase noma i-lumbrokinase enamandla kakhulu womabili anezakhiwo ze-fibrinolytic ne-anticoagulation . Ngaphezu kwalokho, izifunda zokuntuleka kwethusi, ezihlotshaniswa nokungasebenzi kahle kwe-coagulation, kufanele zikhishwe ngenxa yokwanda kwengozi ye-hypercoagulation ebonwa ezigulini ezinethambo lomhlathi.

IMIPHUMELA YOHLELO KANYE NECLINICAL

Ukuba khona kwe-jawbone cavitations kanye ne-pathology ehambisana nayo kuhlanganisa izimpawu ezithile kodwa futhi kuvame ukufaka ezinye izimpawu zesistimu ezingaqondile. Ngakho-ke, ukuxilongwa nokwelashwa kwayo kufanele kubhekwe ngokucophelela yiqembu lokunakekelwa. Ukuqaphela okuyingqayizivele kakhulu futhi okudabukisayo okuye kwavela kusukela ephepheni le-IAOMT 2014 yisinqumo semibandela ebonakala ingahlobene yokuvuvukala okungapheli kulandela ukwelashwa kwe-cavitation. Ukuthi ukugula kwesistimu kungokwemvelo ye-autoimmune noma ukuvuvukala okwenzeka ngenye indlela, ukuthuthuka okubalulekile kubikiwe, okuhlanganisa ukuthuthuka komdlavuza. Izimpawu eziyinkimbinkimbi ezihlotshaniswa nalezi zilonda ziqondene nomuntu ngamunye kakhulu ngakho-ke azikwazi ukujwayelekile noma zibonakala kalula. Ngakho-ke, i-IAOMT inomqondo wokuthi lapho isiguli sitholakala ukuthi sine-jawbone cavitations noma ngaphandle kobuhlungu bendawo obuhlobene, futhi sinezinye izifo zesistimu ngaphambili ezazingabangelwa ama-jawbone cavitations, isiguli sidinga ukuhlolwa okwengeziwe ukuze sinqume ukuthi ukugula kuhlotshaniswa yini , noma kuwumphumela wesifo. I-IAOMT ihlole amalungu ayo ukuze afunde kabanzi mayelana nokuthi yiziphi izimpawu zesistimu/ukugula okuxazululayo ngemva kokuhlinzwa kwe-cavitational. Imiphumela yethulwa kusithasiselo I.

Ukuba khona kwama-cytokines akhiqizwa nge-vascularized kabi, izilonda ze-necrotic ze-jawbone cavitations zibonakala zisebenza njengokugxila kwama-cytokines avuthayo agcina ezinye izindawo zokuvuvukala zisebenza kanye / noma ezingapheli. Impumuzo noma okungenani ukuthuthukiswa ebuhlungwini bemihlathi obulandela ukwelashwa kuyethenjwa futhi kulindeleke, kodwa le mfundiso egxilile yokuvuvukala, ezoxoxwa ngokuningiliziwe ngezansi, ingase ichaze ukuthi kungani izifo eziningi ezibonakala 'zingahlobene' ezinezixhumanisi ezimweni ezingavamile zokuvuvukala. nazo ziyancipha ngokwelashwa kwe-cavitation.

Ukweseka iziphetho ezitholwe ephepheni le-IAOMT lika-2014 elixhumanisa ama-jawbone cavitations kanye nezifo zesistimu, ucwaningo kanye nezifundo zemitholampilo ezisanda kunyatheliswa nguLechner, von Baehr nabanye, zibonisa ukuthi izilonda ze-jawbone cavitation ziqukethe iphrofayili ethile ye-cytokine engabonakali kwamanye ama-pathologies amathambo. . Uma kuqhathaniswa namasampula e-jawbone enempilo, i-cavitation pathologies ikhombisa ngokuqhubekayo ukulawulwa okuqinile kwe-fibroblast growth factor (FGF-2), i-Interleukin 1 receptor antagonist (Il-1ra), futhi, okubaluleke kakhulu, i-RANTES. I-RANTES, eyaziwa nangokuthi i-CCL5 (cc motif Ligand 5) ichazwe njenge-chemotactic cytokine enesenzo esinamandla sokuvuvukala. Lawa ma-chemokines aboniswe ukuthi aphazamisa izigaba eziningana zokusabela komzimba futhi abandakanyeka kakhulu ezimeni ezihlukahlukene ze-pathological kanye nezifo. Ucwaningo luye lwabonisa ukuthi i-RANTES iyathinteka ezifweni eziningi zesistimu ezifana nesifo samathambo, isifo sokukhathala okungamahlalakhona, i-atopic dermatitis, i-nephritis, i-colitis, i-alopecia, ukuphazamiseka kwegilo kanye nokugqugquzelwa kwe-multiple sclerosis nesifo sika-Parkinson. Ngaphezu kwalokho, i-RANTES iboniswe ukuthi ibangela ukusheshisa ukukhula kwesimila .

Izici zokukhula kwe-Fibroblast nazo ziye zathinteka kuma-jawbone cavitations. Izici zokukhula kwe-Fibroblast, i-FGF-2, kanye nama-receptors ahlobene nawo, anesibopho semisebenzi eminingi ebalulekile, okuhlanganisa ukwanda kwamaseli, ukusinda, kanye nokufuduka. Basengozini yokudunwa amaseli omdlavuza futhi badlale indima ye-oncogenic kuma-cancer amaningi. Isibonelo, i-FGF-2 ikhuthaza ukukhula kwesimila kanye nomdlavuza kumdlavuza we-prostate. Ngaphezu kwalokho, amazinga e-FGF-2 abonise ukuhlobana okuqondile nokuqhubekela phambili, i-metastasis kanye nesibikezelo esingesihle sokusinda ezigulini ezinomdlavuza we-colorectal. Uma kuqhathaniswa nezilawuli ezingenawo umdlavuza, iziguli ezine-gastric carcinoma zinamazinga aphezulu kakhulu e-FGF-2 ku-serum yazo. Lezi zithunywa ezivuthayo ziye zathinteka ezifweni eziningi ezimbi noma ngabe ziyimvelo yokuvuvukala noma umdlavuza. Ngokuphambene ne-RANTES/CCL5 ne-FGF-2, i-IL1-ra iboniswe ukuthi isebenze njengomlamuleli oqinile ophikisana nokuvuvukala, okufaka isandla ekuntulekeni kwezibonakaliso ezivamile zokuvuvukala ngaphakathi kwezinye izilonda ze-cavitation.

Amazinga eqile e-RANTES kanye ne-FGF-2 ezilonda ze-cavitation aqhathaniswe futhi axhunyaniswa namazinga abonwa kwezinye izifo zesistimu njenge-amyotrophic lateral sclerosis, (ALS) multiple sclerosis (MS), isifo samathambo kanye nomdlavuza webele. Ngempela, amazinga alezi zithunywa atholwe kuma-jawbone cavitations aphezulu kunaserum noketshezi lwe-cerebrospinal lweziguli ze-ALS ne-MS. Ucwaningo lwamanje olwenziwa nguLechner no-von Baehr lubonise ukwanda okuphindwe ka-26 kwe-RANTES ezilonda ze-osteonecrotic zomhlathi weziguli ezinomdlavuza webele. U-Lechner nozakwabo baphakamisa ukuthi i-cavitation etholwe yi-RANTES ingase isebenze njengokusheshisa ukuthuthuka nokuqhubeka komdlavuza webele .

Njengoba kushiwo ngaphambili, kunezimo eziningi ze-asymptomatic jawbone cavitations. Kulezi zimo, ama-acute pro-inflammatory cytokines afana ne-TNF-alpha ne-IL-6, AKUBONWA emananini anyukile ekutholweni kwe-pathohistological yamasampuli e-cavitation. Kulezi ziguli, ukungabikho kwalawa ma-cytokines ane-pro-inflammatory kuhlotshaniswa namazinga aphezulu e-cytokine elwa nokuvuvukala i-Interleukin 1-receptor antagonist (Il-1ra) . Isiphetho esinengqondo ukuthi ukuvuvukala okunamandla okuhlotshaniswa ne-jawbone cavitations kungaphansi kokulawulwa kwamazinga aphezulu e-RANTES/FGF-2. Ngenxa yalokho, ukwenza ukuxilongwa, u-Lechner no-von Baehr basikisela ukuthi bangagcizeleli ukugxila ebukhoneni bokuvuvukala futhi bacabangele indlela yokubonisa, ngokuyinhloko ngokusebenzisa inkulumo engaphezu kwe-RANTES/FGF-2. Amazinga aphezulu we-RANTES/FGF-2 ezigulini ze-cavitation abonisa ukuthi lezi zilonda zingase zibangele izindlela ezifanayo zokubonisa izimpawu ze-pathogenic kwezinye izitho. Amasosha omzimba asebenza ngokuphendula izimpawu eziyingozi, ezivusa izindlela ezihlukahlukene zamangqamuzana azalwa nazo ezifinyelela umvuthwandaba ekukhiqizweni kwe-cytokine evuthayo kanye nokusebenza okungenzeka kwesimiso somzimba sokuzivikela ezimweni esiguquguqukayo. Lokhu kusekela umbono kanye nethiyori, yokuthi i-jaw bone cavitations ingase isebenze njengembangela eyinhloko yezifo ezivuthayo ezingapheli ngokukhiqizwa kwe-RANTES/FGF-2 futhi kuchaza ngokuqhubekayo ukuthi kungani izimpawu ezinzima zokuvuvukala zingabonwa noma zizwakale isiguli ezilonda zomhlathi. ngokwabo. Ngakho-ke, i-jawbone cavitations kanye nalezi zithunywa ezithintekayo zimelela isici esihlanganisayo sesifo sokuvuvukala futhi sisebenza njenge-etiology engenzeka yesifo. Ukususa ama-cavitations kungase kube isihluthulelo sokubuyisela emuva izifo ezivuthayo. Lokhu kusekelwa ukubhekwa kokunciphisa amazinga e-serum RANTES ukungenelela ngemva kokuhlinzwa ezigulini ezi-5 zomdlavuza webele (Bheka Ithebula 5). Ucwaningo olwengeziwe nokuhlolwa kwamazinga e-RANTES/CCL5 anganikeza ukuqonda kulobu budlelwano. Ukuqaphela okukhuthazayo ukuthuthukiswa kwekhwalithi yokuphila okutholwa iziguli eziningi ze-jawbone cavitation, kungakhathaliseki ukuthi impumuzo endaweni yokusebenza noma ukuncipha kokuvuvukala okungapheli noma izifo kwenye indawo.

Ithebula 5

Ukunciphisa (Okubomvu) ku-RANTES/CCL5 ku-serum ezigulini ezi-5 ezinomdlavuza webele ezihlinzwe i-fatty-degenerative osteonecrosis yomhlathi (FDOJ). Ithebula lithathelwe ku

Lechner et al, 2021. I-Jawbone Cavitation Evezwe I-RANTES/CCL5: Izifundo Zezindaba Ezixhumanisa Ukuvuvukala Okuthulile Emhlathini nge-Epistemology Yomdlavuza Webele.” Umdlavuza Webele: Okuqondisiwe kanye Nokwelashwa.

Izindlela Zokwelapha

Ngenxa yokushoda kwezincwadi zokwelashwa kwezilonda ze-cavitational, i-IAOMT yenza inhlolovo yobulungu bayo ukuze iqoqe ulwazi olumayelana nokuthi yiziphi izindlela zokwelapha ezithuthukayo mayelana 'nezinga lokunakekelwa'. Imiphumela yocwaningo kuxoxwe ngayo kafushane kuSithasiselo II.

Uma indawo nobukhulu bezilonda sekunqunyiwe, izindlela zokwelapha ziyadingeka. I-IAOMT iwumqondo wokuthi ngokuvamile akuvumelekile ukushiya "ithambo elifile" emzimbeni womuntu. Lokhu kusekelwe kudatha ephakamisa ukuthi i-jawbone cavitations ingaba ifoci ye-systemic cytokines nama-endotoxins ukuqala inqubo yokwehlisa isithunzi sempilo iyonke yesiguli .

Ngaphansi kwezimo ezifanele i-biopsy kufanele yenziwe ukuze kuqinisekiswe ukutholakala kwanoma iyiphi i-pathology yomhlathi futhi kukhishwe ezinye izifo zesifo. Khona-ke, ukwelashwa ukususa noma ukuqeda i-pathology ehilelekile futhi kushukumise ukuhluma kabusha kwethambo elivamile, elibalulekile liyadingeka. Ngalesi sikhathi ezincwadini ezibuyekezwe ngontanga, ukwelapha okuhlanganisa ukuhlinza ithambo elingabalulekile elithintekile kubonakala kuwukwelashwa okuthandwayo kwe-jawbone cavitations. Ukwelashwa kuhilela ukusetshenziswa kwezinzwa zendawo, okuholela ekucatshangelweni okubalulekile. Ngaphambilini kwakucatshangwa ukuthi i-epinephrine equkethe izibulala-zinzwa, eziye zazi izici ze-vasoconstrictive, kufanele zigwenywe ezigulini okungenzeka ukuthi kakade ziye zaphazamisa ukuhamba kwegazi okuhambisana nesimo sazo sesifo. Nokho, ochungechungeni lwezifundo zamangqamuzana, ukuhlukaniswa kwe-osteoblastic kwanda ngokusetshenziswa kwe-epinephrine. Ngakho-ke, udokotela kufanele anqume esimweni ngasinye ukuthi asebenzise i-epinephrine futhi uma kunjalo, inani okufanele lisetshenziswe elizonikeza imiphumela engcono kakhulu.

Ngemva kokuhlotshiswa ngokuhlinzwa nokwelashwa okuphelele kwesilonda nokuniselwa ngosawoti ovamile oyinyumba, ukuphulukiswa kuthuthukiswa ngokufakwa kwamagrafti e-platelet-rich fibrin (PRF) endaweni engenalutho. Ukusetshenziswa kwe-platelet-rich fibrin egxile ezinqubweni zokuhlinza akuzuzisi nje kuphela ngokombono wokujiyisa, kodwa futhi kusukela esicini sokukhulula izici zokukhula esikhathini esingafika ezinsukwini eziyishumi nane ngemva kokuhlinzwa. Ngaphambi kokusetshenziswa kokuxhunyelelwa kwe-PRF nezinye izindlela zokwelapha ezihambisanayo, ukuphindeka kwesilonda se-osteonecrotic somhlathi ngemva kokuhlinzwa kwenzeke cishe ku-40% wamacala.

Ukucutshungulwa kwezici zengozi zangaphandle ezichazwe kuThebula lesi-2 kuphakamisa ngokuqinile ukuthi imiphumela engalungile ingagwenywa ngendlela efanele yokuhlinza kanye nokusebenzisana kodokotela/nesiguli, ikakhulukazi kubantu abasengozini. Kutuswa ukuthi ucabange ukusebenzisa amasu e-atraumatic, ukunciphisa noma ukuvimbela izifo ze-periodontal nezinye izifo zamazinyo, nokukhetha i-armamentarium ezovumela imiphumela engcono kakhulu yokuphulukisa. Ukunikeza imiyalelo ephelele ngaphambi nangemuva kokuhlinzwa esigulini, okuhlanganisa izingozi ezihlobene nokubhema ugwayi kungasiza ekunciphiseni imiphumela engemihle.

Ngokukhumbula uhlu olubanzi lwezinto ezingaba yingozi ezisohlwini lweThebula 2 no-3, ukubonisana nethimba lokunakekelwa okwenwetshiwe lesiguli kunconywa ukuze kuqinisekiswe kahle noma yiziphi izici eziyingozi ezifihliwe ezingase zibe nomthelela ekuthuthukisweni kwe-jawbone cavitations. Isibonelo, ukucatshangelwa okubalulekile lapho welapha i-jawbone cavitations ukuthi ngabe umuntu uthatha ama-antidepressants, ikakhulukazi ama-serotonin reuptake inhibitors (SSRIs) akhethiwe. Ama-SSRI ahlotshaniswe nokuncipha kokuminyana kwesisindo samathambo kanye namazinga anyukile okuphuka. I-SSRI Fluoxetine (Prozac) ivimbela ngokuqondile ukuhlukaniswa kwe-osteoblast kanye nokwenza amaminerali. Okungenani izifundo ezimbili ezizimele ezihlola abasebenzisi be-SSRI ngokuqhathaniswa nezilawuli zibonise ukuthi ukusetshenziswa kwe-SRRI kuhlotshaniswa nezinkomba ze-panoramic morphometric ezimbi kakhulu.

I-preconditioning ingase ibe nomthelela emiphumeleni yokwelashwa eyimpumelelo. Lokhu kuhilela ukudala indawo yezicubu evumela ukuphulukiswa ngokunikeza umzimba amazinga anele emisoco efanele ethuthukisa indawo yebhayoloji ngokwenza i-homeostasis ibe ngcono emzimbeni. Amaqhinga okulungisa isimo akwenzeki ngaso sonke isikhathi, noma amukeleke esigulini, kodwa abaluleke kakhulu kulezo ziguli ezaziyo izinto ezithintekayo, njengalezo ezinofuzo, ukuphazamiseka kokuphulukisa noma impilo esengozini. Ezimweni ezinjalo, kubalulekile ukuthi lokhu kulungiselelwa kwenzeke ukuze kuncishiswe amazinga okucindezeleka okwenziwe nge-oxidative, okungagcini nje ukuvuselela inqubo yesifo kodwa kungaphazamisa ukuphulukiswa okufunayo.

Ngokufanelekile, ukuncishiswa kwanoma yimuphi umthwalo onobuthi emzimbeni ofana ne-fluoride kanye/noma i-mercury kusukela ekugcwalisweni kwe-amalgam yamazinyo kufanele kuqedwe ngaphambi kokwelashwa kwe-jawbone cavitations. I-Mercury ingasusa insimbi ochungechungeni lwezokuthutha lwe-electron lwe-mitochondria. Lokhu kubangela insimbi yamahhala eyeqile (i-iron eyoniwe noma i-Fe++), ekhiqiza izinhlobo ze-oxygen esebenzayo (ROS) ezilimazayo ezaziwa nangokuthi ama-radicals mahhala, abangela ukucindezeleka kwe-oxidative. Insimbi eyeqile esicutshini samathambo iphinde ivimbele ukusebenza kahle kwama-osteoblasts, ngokusobala azoba nomthelela omubi lapho ezama ukwelapha ukuphazamiseka kwamathambo .

Okunye ukushiyeka kufanele kuxazululwe ngaphambi kokwelashwa. Lapho kukhona ukuntuleka kwe-bioavailable yethusi, i-magnesium ne-retinol, i-metabolism kanye nokugaywa kabusha kwe-iron kuyaphazamiseka emzimbeni, okunomthelela ekusetshenzisweni kwe-iron yamahhala ezindaweni ezingafanele okuholela ekucindezelekeni okukhulu kwe-oxidative kanye nengcuphe yezifo. Ngokuqondile, ama-enzyme amaningi emzimbeni (njenge-ceruloplasmin) ayayeka ukusebenza lapho amazinga anganele ethusi elitholakala nge-bioavailable, i-magnesium, ne-retinol, abese eqhubekisela phambili ukungasebenzi kahle kwe-iron kanye nomphumela wokwanda kokucindezeleka okwenziwe nge-oxidative nobungozi besifo .

Amanye Amasu Okwelapha

Ezinye izindlela zokwelashwa ezisetshenziswa njengezindlela zokwelapha eziyinhloko noma ezisekelayo nazo kufanele zihlolwe. Lokhu kufaka phakathi i-homeopathy, ukuvuselela ugesi, ukwelapha okukhanyayo okufana ne-photobiomodulation, ne-laser, i-oxygen/i-ozone yezokwelapha, i-hyperbaric oxygen, izindlela zokunqanda ukuphuma kwegazi, amakhambi e-Sanum, umsoco kanye ne-nutraceuticals, i-infra-red sauna, i-ozone therapy, ukwelashwa kwamandla, nokunye. Ngalesi sikhathi, isayensi ayizange yenziwe ezoqinisekisa lezi zindlela zokwelapha ezihlukile ukuthi ziyasebenza noma zingasebenzi. Amazinga okunakekelwa okuqinisekisa ukuphulukiswa okufanele kanye nokukhishwa kwe-detoxification kufanele kusungulwe. Amasu okuhlola impumelelo kufanele ahlolwe futhi afane. Izinqubo zomthetho noma izinqubo zokusiza ukunquma ukuthi ukwelashwa kufaneleka nini nokuthi kungafanele nini kufanele kubekwe ukuze kuhlolwe.

IMIBUZO

Ucwaningo luye lwabonisa ukuthi ukuba khona kwama-jawbone cavitations kuyinqubo yesifo ecashile ehambisana nokuncipha kokugeleza kwegazi . Ukugeleza kwegazi okuphazamisekile kwe-medullary kuholela ekungeneni kwamaminerali kanye nokunganele kwe-vascularization ezindaweni zomhlathi ezingase zitheleleke ngama-pathogens, okuthuthukisa ukufa kwamaselula. Ukugeleza kwegazi okuvilaphayo ngaphakathi kwezilonda ze-cavitational kubekela inselele ukulethwa kwama-antibiotic, izakhi kanye nezithunywa zokuzivikela komzimba. Imvelo ye-ischemic nayo ingabamba futhi ikhuthaze abalamuli bokuvuvukala okungamahlalakhona abangaba nemiphumela eyingozi nakakhulu empilweni yesistimu. Ukuthambekela kofuzo, ukuncipha kokuzivikela komzimba, imiphumela yemithi ethile, ukuhlukumezeka nokungenwa izifo, nezinye izici ezinjengokubhema kungase kubangele noma kusheshise ukwakheka kwethambo lomhlathi .

Kanye nodokotela ovelele wezifo zethambo lomhlathi, uDkt. Jerry Bouquot, i-IAOMT yethula futhi ikhuthaza ukuhlonzwa okulungile ngokomlando kanye ne-pathologically kwezilonda ze-jawbone cavitational njenge-Chronic Ischemic Medullary Disease of the Jawbone, CIMDJ. Nakuba amagama amaningi, ama-acronyms, namagama anomlando futhi okwamanje asetshenziselwa ukukhombisa lesi sifo, i-IAOMT iyaqiniseka ukuthi leli yigama elifanele kakhulu ukuchaza isimo se-pathologic kanye ne-micro-histologic evame ukutholakala kuma-jawbone cavitations.

Nakuba izilonda eziningi ze-jawbone cavitational zinzima ukuxilonga nge-radiographs evamile futhi iningi alibuhlungu, umuntu akufanele neze acabange ukuthi inqubo yesifo ayikho. Kunezinqubo eziningi zezifo okunzima ukuzixilonga, futhi eziningi azibuhlungu. Uma sisebenzisa izinhlungu njengenkomba yokwelashwa, isifo se-periodontal, isifo sikashukela kanye nomdlavuza omningi bekungeke kulashwe. Udokotela wamazinyo wanamuhla unezinhlobo eziningi zezindlela zokwelapha ngempumelelo i-jawbone cavitations kanye nokwehluleka ukuvuma ukuthi lesi sifo futhi atusa ukwelashwa akubi kangako njengokwehluleka ukuhlonza nokwelapha isifo se-periodontal. Ngempilo kanye nenhlalakahle yeziguli zethu, ukuguquguquka kwepharadigm kubalulekile kubo bonke ochwepheshe bezokunakekelwa kwempilo, okuhlanganisa nodokotela bamazinyo nabezokwelapha, ukuze 1) babone ukusabalala kwe-jawbone cavitations kanye 2) bavume ukuxhumana phakathi kwe-jawbone cavitations kanye nesifo sesistimu.

ISITHASISELO I

IMIPHUMELA 2 YE-IAOMT SURVEY (2023)

Njengoba kuxoxwe kafushane ephepheni, izimo ezingahlobene zivame ukukhulula ngemuva kokuhlinzwa kwe-cavitation. Ukuze ufunde kabanzi mayelana nokuthi yiziphi izinhlobo zezimo ezixazululekayo nokuthi ukukhululwa okuseduze kwenzeka kanjani ngokuphathelene nokuhlinzwa, inhlolovo yesibili yathunyelwa ebulungwini be-IAOMT. Uhlu lwezimpawu nezimo amalungu ale komiti aye aziqaphela ziba ngcono ngemva kokuhlinzwa ukuze kwenziwe ucwaningo. Abaphenduli babuzwa ukuthi ngabe bake babona noma yiziphi zalezi zimo eziguqukayo ngemva kokuhlinzwa, futhi uma kunjalo ngezinga elingakanani. Baphinde babuzwa ukuthi ngabe izimpawu zisheshe ziphele noma ngabe ukuthuthukiswa kuthathe isikhathi esingaphezu kwezinyanga ezimbili. Ukwengeza, abaphendulile babuzwa ukuthi ingabe ngokuvamile bahlinze amasayithi ngamanye, amasayithi amaningi ahlangene, noma wonke amasayithi ekuhlinzeni okukodwa. Imiphumela yocwaningo yethulwe eMidwebeni engezansi. Imininingwane ingeyokuqala, uma kubhekwa inani labaphendulile belincane (33) nokuthi kunedatha engekho.

Appx I Fig 1 Abaphendulayo balinganise izinga lokuthuthuka (elithambile, elimaphakathi noma elibalulekile) futhi baqaphela ukuthi ukuthuthukiswa kwenzeke ngokushesha (izinyanga ezi-0-2) noma kuthathe isikhathi eside (> izinyanga ezi-2). Izimo/izimpawu zibhalwe ngokulandelana kweziningi ezibikiwe. Qaphela ukuthi izimo eziningi/izimpawu ezisusiwe esikhathini esingaphansi kwezinyanga ezimbili (uhlangothi lwesobunxele lomugqa omaphakathi).

Appx I Fig 2 Njengoba kukhonjisiwe ngenhla, ezimweni ezimbalwa, Abaphenduli abazange baphawule isikhathi esibekelwe ukutholwa kokuthuthukiswa okubonwayo.

Appx I Fig 3 Abaphendulayo baphendule embuzweni, “Ingabe uvamise ukuncoma/wenza

ukuhlinza iziza ngazinye, izindawo ezihlangene ezilashwa ndawonye, ​​noma zonke izingosi ezilashwa ngokuhlinzwa okukodwa?”

ISITHASISELO II

IMIPHUMELA 1 YE-IAOMT SURVEY (2021)

Ngenxa yokushoda kwezincwadi kanye nokubuyekezwa kwecala lomtholampilo elihlobene nokwelashwa kwezilonda ze-cavitational, i-IAOMT ihlole ubulungu bayo ukuze iqoqe ulwazi olumayelana nokuthi yiziphi izitayela nezindlela zokwelapha ezithuthukayo eziqonde 'endinganisweni yokunakekelwa'. Inhlolovo ephelele iyatholakala kuwebhusayithi ye-IAOMT (qaphela ukuthi akubona bonke odokotela abaphendule yonke imibuzo yocwaningo).

Ukufingqa kafushane, iningi labaphendulile be-79 banikeza ukwelashwa kokuhlinzwa, okubandakanya ukubonakaliswa kwezicubu ezithambile, ukufinyelela kokuhlinzwa kwendawo ye-cavitation, nezindlela ezihlukahlukene 'zokuhlanza' ngokomzimba nokubulala amagciwane endaweni ethintekile. Izinhlobonhlobo zemithi, i-nutraceuticals, kanye/noma imikhiqizo yegazi isetshenziselwa ukukhuthaza ukuphulukiswa kwesilonda ngaphambi kokuvala ukusika kwezicubu ezithambile.

Ama-Rotary burs avame ukusetshenziselwa ukuvula noma ukufinyelela isilonda samathambo. Odokotela abaningi basebenzisa insimbi yesandla ukuze belaphe noma bakhiphe ithambo eligulayo (68%), kodwa amanye amasu namathuluzi abuye asetshenziswe, njenge-rotary bur (40%), i-piezoelectric (ultrasonic) instrument (35%) noma ER:YAG laser (36%), okuyifrikhwensi ye-laser esetshenziselwa ukusakaza nge-photoacoustic .

Uma isayithi selihlanziwe, selichithiwe, kanye/noma selilungisiwe, iningi labaphendulayo basebenzisa amanzi/igesi ye-ozone ukuze kubulawe amagciwane kanye nokukhuthaza ukuphulukiswa. U-86% wabaphenduli basebenzisa i-PRF (i-platelet-rich fibrin), i-PRP (i-plasma ecebile nge-platelet) noma i-PRF e-ozonated noma i-PRP. Indlela ethembisayo yokubulala amagciwane ebikwe ezincwadini futhi ngaphakathi kwale nhlolovo (42%) ukusetshenziswa ngokuhlanganyela kwe-Er:YAG . I-32% yabaphenduli ayisebenzisi noma yiluphi uhlobo lwe-bone graft ukugcwalisa indawo ye-cavitation.

Iningi labaphendulayo (59%) ngokuvamile aliyihloli izilonda ezisho izizathu ezihlukahlukene zezindleko, ukungakwazi ukuthola amasampula ezicubu ezisebenzayo, ubunzima bokuthola ilebhu ye-pathology, noma isiqiniseko sesimo sesifo.

Iningi labaphendulayo aliwasebenzisi ama-antibiotic ngaphambi kokuhlinzwa (79%), ngesikhathi sokuhlinzwa (95%) noma ngemva kokuhlinzwa (69%). Okunye ukwesekwa kwe-IV okusetshenzisiwe kufaka i-dexamethasone steroids (8%) kanye namaVithamini C (48%). Abaningi abaphendulayo (52%) basebenzisa i-low level laser therapy (LLLT) post ngokuhlinza ngezinjongo zokwelapha. Abaningi abaphendulayo batusa ukwesekwa kwezakhi ezihlanganisa amavithamini, amaminerali, kanye ne-homeopathic ehlukahlukene ngaphambi kuka (81%) kanye naphakathi (93%) nesikhathi sokuphulukiswa.

ISITHASISELO III

Izithombe

I-Appx III Fig 1 Iphaneli yesokunxele: Ukuxilongwa kwe-X-ray ye-2D yendawo #38. Iphaneli yesokudla: Amadokhumenti omkhathi we-FDO) endaweni ye-retromolar 38/39 kusetshenziswa i-ejenti yokuqhathanisa ngemva kokuhlinzwa kwe-FDOJ.

Izifinyezo: I-FDOJ, i-fatty degenerative osteonecrosis yomhlathi.

Ithathelwe ku-Lechner, et al, 2021. “I-Jawbone Cavitation Evezwe I-RANTES/CCL5: Izifundo Zezikesi Ezixhumanisa Ukuvuvukala Okuthule Emhlathini nge-Epistemology Yomdlavuza Webele.” Umdlavuza Webele: Okuqondisiwe kanye Nokwelashwa

Appx 3 Fig 2 Ukuqhathaniswa kwama-cytokines ayisikhombisa (FGF-2, IL-1ra, IL-6, IL-8, MCP-1, TNF-a kanye ne-RANTES) ku-FDOJ ngaphansi kwe-RFT #47 nama-cytokines emhlathini onempilo (n = 19). Amadokhumenti okusebenza okunwetshwa kwe-FDOJ emhlathini ongezansi kwesokudla, indawo engu-#47 ngokwesilinganiso se-RFT #47, nge-ejenti ehlukile ngemva kokukhishwa kokuhlinzwa kwe-RFT #47.

Izifinyezo: I-FDOJ, i-fatty degenerative osteonecrosis yomhlathi.

Kuthathwe ku-Lechner no-von Baehr, 2015. "I-Chemokine RANTES/CCL5 Njengesixhumanisi Esingaziwa Phakathi Kokuphulukiswa Kwenxeba Emhlathini kanye Nezifo Ezihleliwe: Ingabe Ukubikezela Nokwelashwa Okuhlanganisiwe Kusemkhathizwe?" Iphephabhuku le-EPMA

I-Appx III Fig 3 Inqubo yokuhlinzwa ye-retromolar BMDJ/FDOJ. Iphaneli yesokunxele: ngemva kokugoqa phansi i-mucoperiosteal flap, kwakhiwa iwindi lethambo ku-cortex. Iphaneli yesokudla: umgodi we-medullary olashiwe.

Izifinyezo: BMDJ, ukukhubazeka komnkantsha emhlathini; I-FDOJ, i-fatty degenerative osteonecrosis yomhlathi.

Ithathelwe ku-Lechner, et al, 2021. “I-Chronic Fatigue Syndrome kanye Nokukhubazeka Kwethambo Lomnkantsha Emhlathini – Umbiko Wecala Lokuhlonzwa Kwe-X-Ray Yamazinyo Okwengeziwe nge-Ultrasound.” Ijenali ye-International Medical Case Reports

I-Appx III Fig 4 (a) Ukwelashwa kwe-FDOJ emhlathini ongezansi ngenzwa ye-infra-alveolar ene-denuded. (b) I-X-ray ehambisanayo ngaphandle kwezimpawu zenqubo ye-pathological emhlathini.

Izifinyezo: I-FDOJ, i-fatty degenerative osteonecrosis yomhlathi

Kuthathwe ku-Lechner, et al, 2015. "I-Peripheral Neuropathic Facial/Trigeminal Pain kanye ne-RANTES/CCL5 ku-Jawbone Cavitation." Imithi Ehambisana Nezobuchwepheshe Nezokwelapha

I-Appx III Movie 1

Isiqeshana sevidiyo (chofoza kabili esithombeni ukuze ubuke isiqeshana) sokuhlinzwa kwethambo lomhlathi okubonisa ama-globules akhuluphele kanye nokuphuma ubovu emhlathini wesiguli ebekusolwa ukuthi sine-necrosis yomhlathi. Ngenhlonipho kaDkt. Miguel Stanley, DDS

I-Appx III Movie 2

Isiqeshana sevidiyo (chofoza kabili esithombeni ukuze ubuke isiqeshana) sokuhlinzwa kwethambo lomhlathi okubonisa ama-globules akhuluphele kanye nokuphuma ubovu emhlathini wesiguli ebekusolwa ukuthi sine-necrosis yomhlathi. Ngenhlonipho kaDkt. Miguel Stanley, DDS

Ukulanda noma ukuphrinta leli khasi ngolimi oluhlukile, khetha ulimi lwakho kumenyu yokudonsela phansi phezulu kwesokunxele kuqala.

I-IAOMT Position Paper on Human Jawbone Cavitations Authors