Ho daunelouda kapa ho hatisa leqephe lena ka puo e 'ngoe, khetha puo ea hau ho tsoa lethathamong le kaholimo ho le letšehali pele.

IAOMT Position Paper on Human Jawbone Cavitations

Molula-setulo oa Komiti ea Jawbone Pathology: Ted Reese, DDS, MAGD, NMD, FIAOMT

Karl Anderson, DDS, MS, NMD, FIAOMT

Patricia Berube, DMD, MS, CFMD, FIAOMT

Mosebetsi oa 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

Komiti e rata ho bontša kananelo ea rona ho Michael Gossweiler, DDS, MS, NMD, Miguel Stanley, DDS le Stuart Nunally, DDS, MS, FIAOMT, NMD bakeng sa litlhaloso tsa bona tsa pampiri ena. Hape re lakatsa ho ananela tlatsetso ea bohlokoahali le boiteko bo entsoeng ke Dr. Nunnally ha a hlophisa pampiri ea boemo ba 2014. Mosebetsi oa hae, mahlahahlaha le boithuto ba hae li ile tsa fana ka mokokotlo oa pampiri ena e ntlafalitsoeng.

E amohetsoe ke Boto ea Batsamaisi ba IAOMT Loetse 2023

Lethathamo la Tse ka Hare

Selelekela

History

tepelletse maikutlong

Cone beam computed tomography (CBCT)

Ultrasound

Li-Biomarker le Tlhahlobo ea Histological

Mehopolo e Tsoelang Pele bakeng sa ho hlahloba

Litšoantšo

Tlhahlobo ea Acupuncture Meridian

Lintho Tse Kotsing

Liphello tsa Tsamaiso le Meriana

Mekhoa ea Kalafo

Mekhoa e meng ea Kalafo

Nahanisisa

References

Sehlomathiso I IAOMT Survey 2 Liphetho

Sehlomathiso II IAOMT Survey 1 Liphetho

Sehlomathiso III Images

Setšoantšo sa 1 Fatty degenerative osteonecrosis of the jawbone (FDOJ)

Setšoantšo sa 2 Cytokines ho FDOJ bapisoa le Healthy Controls

Setšoantšo sa 3 Mokhoa oa ho buoa bakeng sa FDOJ ea retromolar

Setšoantšo sa 4 Phepo le x-ray e tsamaellanang ea FDOJ

Lifilimi Likotoana tsa video tsa opereishene ea mohlahare ho bakuli

SELELEKELA

Lilemong tse leshome tse fetileng ho bile le tlhokomeliso e ntseng e eketseha har'a sechaba le bafani ba tlhokomelo ea bophelo mabapi le kamano pakeng tsa bophelo bo botle ba molomo le tsamaiso. Ka mohlala, lefu la periodontal ke kotsi ea lefu la tsoekere le lefu la pelo . Khokahano e ka bang teng le e ntseng e tsoela pele ho etsoa liphuputso e boetse e bontšitsoe pakeng tsa lefu la mohlahare le bophelo bo botle le matla a motho ka kakaretso . Tšebeliso ea mekhoa ea litšoantšo e tsoetseng pele ea theknoloji e kang cone-beam computed tomography (CBCT) e thusitse haholo ho tsebahatsa mafu a mohlahare, e leng se lebisitseng ho ntlafatseng bokhoni ba ho hlahloba le ho ntlafatsa bokhoni ba ho hlahloba katleho ea mehato ea ho buuoa . Litlaleho tsa mahlale, li-docudramas le mecha ea litaba ea sechaba li ekelitse tlhokomeliso ea sechaba ka li-pathologies tsena, haholo-holo har'a batho ba tšoeroeng ke maemo a sa foleng a sa foleng a methapo ea kutlo kapa a systemic a hlolehang ho arabela lits'ebetsong tsa setso tsa bongaka kapa tsa meno.

International Academy of Oral Medicine le Toxicology (IAOMT) e thehiloe holim'a tumelo ea hore saense e lokela ho ba motheo oo ho oona mekhoa eohle ea ho hlahloba le ea phekolo e khethiloeng le ho sebelisoa. Ke ka taba ena e tlang pele kelellong ea rona hore re 1) re fane ka ntlafatso ena ho 2014 IAOMT Jawbone Osteonecrosis Position Paper, le 2) e sisinya, ho latela tlhahlobo ea histological, lebitso le nepahetseng ho feta saense le meriana bakeng sa lefu lena, haholo-holo, Chronic Ischemic Medullary Disease. ea Mohlahare (CIMDJ). CIMDJ e hlalosa boemo ba lesapo bo khetholloang ke lefu la likarolo tsa cellular tsa lesapo la ho hlakoloa, ho latela ho sitisoa ha phepelo ea mali. Ho pholletsa le histori ea eona, seo re se bitsang CIMDJ se 'nile sa boleloa ke bongata ba mabitso le li-acronyms tse thathamisitsoeng ho Lethathamo la 1' me li tla tšohloa ka bokhutšoanyane ka tlase.

Sepheo le sepheo sa Academy le pampiri ena ke ho fana ka litsebi tsa saense, lipatlisiso, le litsebi tsa bongaka bakeng sa bakuli le lingaka ho etsa liqeto tse nang le tsebo ha ba nahana ka likokoana-hloko tsena tsa CIMDJ, tseo hangata li bitsoang li-jawbone cavitations. Pampiri ena ea 2023 e entsoe ka boiteko bo kopanetsoeng bo kenyeletsang lingaka, bafuputsi le setsebi se tummeng sa mafu a mohlahare, Dr. Jerry Bouquot, ka mor'a tlhahlobo ea lihlooho tse fetang 270.

PELE

Ha ho lesapo le leng moo ho nang le monyetla oa ho sithabela maikutlo le ho tšoaetsoa mafu a maholo joaloka marapong a mohlahare. Tlhahlobo ea lingoliloeng tse amanang le sehlooho sa jawbone cavitations, (ke hore, CIMDJ) e bontša hore boemo bona bo 'nile ba fumanoa, ba phekoloa le ho batlisisoa ho tloha lilemong tsa bo-1860. Ka 1867, Dr. HR Noel o ile a fana ka puo e nang le sehlooho se reng Thuto ka caries le necrosis ea lesapo ho Baltimore College of Dental Surgery, 'me ka 1901 li-cavitations tsa mohlahare li tšohloa ka nako e telele ke William C. Barrett bukeng ea hae e nang le sehlooho se reng, Oral Pathology and Practice: A Textbook for the Use of Students in Dental Colleges and Handbook for Dental Practitioners . GV Black, eo hangata a bitsoang ntate oa bongaka ba meno ba mehleng ea kajeno, o kenyelelitse karolo bukeng ea hae ea 1915, Special Dental Pathology, ho hlalosa 'ponahalo e tloaelehileng le phekolo ea' seo a se hlalositseng e le mohlahare oa lefuba (JON) .

Lipatlisiso tse mabapi le li-cavitations tsa mohlahare li ile tsa bonahala li emisa ho fihlela lilemong tsa bo-1970 ha ba bang ba qala ho etsa lipatlisiso ka taba ena, ba sebelisa mabitso le lileibole tse fapa-fapaneng, ’me ba hatisa boitsebiso bo mabapi le eona libukeng tsa sejoale-joale tsa lefu la molomo . Ka mohlala, ka 1992 Bouquot et al o ile a hlokomela ho ruruha ha intraosseous ho bakuli ba nang le bohloko bo sa foleng le bo matla ba sefahleho (N = 135) 'me ba qapa lentsoe' Neuralgia-inducing Cavitational Osteonecrosis ', kapa NICO. Le hoja Bouquot et al ba sa ka ba bua ka etiology ea lefu lena, ba ile ba etsa qeto ea hore ho ka etsahala hore ebe lisosa li ile tsa etsa hore ho be le neuralgia ea sefahleho e sa foleng e nang le likarolo tse ikhethang tsa sebaka seo: sebopeho sa intraosseous cavity le necrosis ea nako e telele ea masapo e nang le pholiso e fokolang. Phuputsong ea kliniki ea bakuli ba nang le trigeminal (N = 38) le facial (N = 33) neuralgia, Ratner et al, o ile a boela a bontša hore hoo e batlang e le bakuli bohle ba ne ba e-na le marapo a masapo a alveolar le mohlahare. Maroba, ka linako tse ling a feta 1 cm ka bophara, a ne a le libakeng tseo ho neng ho ntšoa leino nakong e fetileng 'me hangata a ne a sa bonoe ka x-ray.

Ho na le mantsoe a mang a fapaneng bakeng sa seo re se bitsang CIMDJ libukeng. Tsena li thathamisitsoe ho Lethathamo la 1 'me li tšohloa hakhutšoanyane mona. Adams et al o ile a qapa lentsoe Chronic Fibrosing Osteomyelitis (CFO) pampiring ea boemo ba 2014. Pampiri ea boemo e ne e le sephetho sa sehlopha sa litsebi tse fapaneng tsa lingaka tse tsoang mafapheng a Oral Medicine, Endodontics, Oral Pathology, Neurology, Rheumatology, Otolaryngology, Periodontology, Psychiatry, Oral and Maxillofacial Radiology, Anesthesia, General Dentistry, Internal Medicine, . Sepheo sa sehlopha e ne e le ho fana ka sethala sa lihlopha tse fapaneng ho phekola mafu a amanang le hlooho, molala le sefahleho. Ka boiteko bo kopanetsoeng ba sehlopha sena, lipatlisiso tse pharaletseng tsa lingoliloeng le lipuisano tsa bakuli, ho ile ha hlaha mokhoa o ikhethileng oa kliniki, oo ba o bitsitseng CFO. Ba hlokometse hore lefu lena hangata ha le hlahlojoe ka lebaka la ho kopana ha lona le maemo a mang a tsamaiso. Sehlopha sena se bontšitse likhokahano tse ka bang teng lipakeng tsa lefu lena le litaba tsa bophelo bo botle le tlhokahalo ea sehlopha sa lingaka ho hlahloba hantle le ho phekola mokuli .

Leqeba la mohlahare oa cavitational le boetse le hlokometsoe ho bana. Ka 2013, Obel et al o hlalositse liso tsa bana mme a qapa lentsoe Juvenile Mandibular Chronic Osteomyelitis (JMCO). Sehlopha sena se ile sa etsa tlhahiso ea hore ho sebelisoe li-bisphosphonate tse intravenous (IV) e le phekolo bakeng sa bana bana. Ka 2016 Padwa et al o ile a hatisa phuputso e hlalosang lefu la ho ruruha ha masapo ho bakuli ba mafu a bana. Ba ile ba ngola leqeba la Pediatric Chronic Nonbacterial Osteomyelitis (CNO).

Ho tloha ka 2010, Dr. Johann Lechner, mongoli le mofuputsi ea hatisitsoeng ka ho fetisisa ka li-jawbone cavitational lesions, le ba bang ba 'nile ba batlisisa kamano ea lisosa tsena le tlhahiso ea cytokine, haholo-holo ho ruruha ha cytokine RANTES (e tsejoang hape e le CCL5). Dr. Lechner o sebelisitse mantsoe a sa tšoaneng ho hlalosa lisosa tsena tse kenyelelitseng NICO e boletsoeng pejana empa hape le Aseptic Ischemic Osteonecrosis ka Jawbone (AIOJ), le Fatty Degenerative Osteonecrosis ea Jawbone (FDOJ) . Tlhaloso/leibole ea hae e ipapisitse le chebahalo ea 'mele le/kapa boemo ba macroscopically pathological bo hlokomeloa ka bongaka kapa ka har'a ts'ebetso.

Hona joale ho na le tlhokahalo ea ho hlakisa e 'ngoe e sa tsoa tsejoa morao tjena ea lefu la mohlahare e fapaneng le sehlooho sa pampiri ena empa e ka ferekanya ho ba batlisisang lisosa tsa cavitational. Tsena ke maqeba a masapo a mohlahare a hlahang ka lebaka la tšebeliso ea meriana. Maqeba a bonahala ka ho fetisisa ka ho lahleheloa ke phepelo ea mali ka mor'a hore lesapo le se ke la laoleha. Maqeba ana a bitsitsoe Oral Ulceration with Bone Sequestration (OUBS) ke Ruggiero et al bukeng ea boemo ba. Mokhatlo oa Amerika oa Lingaka tsa Meno le tsa Maxillofacial (AAOMS), hammoho le Palla et al, tlhahlobo e hlophisitsoeng . Kaha bothata bona bo amana le tšebeliso ea meriana e le 'ngoe kapa e mengata, IAOMT e na le maikutlo a hore mofuta ona oa leqeba o hlalosoa ka ho fetisisa e le Osteonecrosis e amanang le Meriana ea Jaw (MRONJ). MRONJ e ke ke ea tšohloa pampiring ena kaha etiology le mekhoa ea kalafo ea eona e fapane le eo re e bitsang CIMDJ, 'me e kile ea ithutoa haholo pele .

LIEKETSENG TS'OANYANE

Tšebeliso e ntseng e eketseha ea Cone-beam computed tomography (CBCT) radiographs ke lingaka tse ngata tsa meno e entse hore ho be le keketseho ea ho boloka li-cavitations tsa intramedullary tseo re li bitsang CIMDJ, le tseo pele li neng li hlokomolohuoa 'me kahoo li hlokomolohuoa. Kaha joale maqeba ana le liphapang li se li fumaneha habonolo, e fetoha boikarabello ba mosebetsi oa meno ho hlahloba lefu lena le ho fana ka likhothaletso le tlhokomelo ea kalafo.

Ho ananela le ho tseba boteng ba CIMDJ ke qalo ea ho e utloisisa. Ho sa tsotellehe mabitso a mangata le li-acronyms tse 'nileng tsa amahanngoa le lefu lena, boteng ba necrotic, kapa lesapo le shoang karolong ea medullary ea mohlahare e thehiloe hantle.

Ha li bonoa nakong ea ho buuoa, likoli tsena tsa masapo li itlhahisa ka litsela tse ngata. Litsebi tse ling li tlaleha hore liso tse fetang 75% ha li na letho kapa li tletse ka lisele tse bonolo, tse sootho le tse nang le mafura a 'mala o mosehla (li-cysts tsa oli) tse fumanoang libakeng tse nang le bokooa tse nang le sebopeho se tloaelehileng sa masapo. Ba bang ba tlaleha boteng ba li-cavitations tse nang le botenya bo fapaneng ba cortical botenya, hoo ha bo buloa, bo bonahalang bo e-na le masela a nang le likhoele tse ntšo, tse sootho kapa tse putsoa. Ba bang ba tlaleha liphetoho tse tebileng ka tsela e fapaneng tse hlalosoang e le "gritty", "joaloka sawdust", "gollow cavities", le "omeletseng" ka linako tse ling sclerotic, joalo ka leino le thata la mabota. Ha ho hlahlojoa histological, lisosa tsena li bonahala li tšoana le necrosis e hlahang masapong a mang a 'mele' me e fapane le histologically ho osteomyelitis (Sheba setšoantšo sa 1). Litšoantšo tse ling tse bontšang lefu la CIMDJ, tse ling tse nang le litšoantšo tse hlakileng, li kenyelelitsoe Sehlomathisong sa III qetellong ea tokomane ena.

Setšoantšo sa 1 Litšoantšo tsa CIMDJ tse nkiloeng ho cadaver

Joalo ka lingaka tse ling tsa tlhokomelo ea bophelo bo botle, lingaka tsa meno li sebelisa mokhoa o hlophisitsoeng o sebelisang mekhoa le mekhoa e fapaneng ho hlahloba liso tsa cavitational. Tsena li ka kenyelletsa ho etsa tlhahlobo ea 'mele e kenyelletsang ho nka nalane ea bophelo bo botle, ho lekola matšoao, ho fumana maro a 'mele ho etsa liteko tsa laboratori, le ho fumana lisampole tsa 'mele bakeng sa biopsy le tlhahlobo ea microbiological (ke hore, tlhahlobo ea boteng ba likokoana-hloko). Mekhoa ea ho etsa litšoantšo, joalo ka CBCT le eona e sebelisoa hangata. Ho bakuli ba nang le mathata a rarahaneng ao kamehla a sa lateleng mohlala kapa a lumellana le tatellano e tloaelehileng ea matšoao a rarahaneng, mokhoa oa ho hlahloba o ka hloka tlhahlobo e qaqileng haholoanyane eo qalong e ka fellang feela ka ho khetholla ka tsela e fapaneng. Litlhaloso tse khutšoane tsa mekhoa e mengata ea tlhahlobo ea mafu li fanoe ka tlase.

Cone beam computed tomography (CBCT)

Mekhoa ea ho hlahloba e hlalositsoeng pele ho 1979 ke Ratner le basebetsi-'moho le eena, ho sebelisa digital palpation le likhatello, liente tsa ho hlahloba li-anesthetic tsa sebakeng seo, ho nahanisisa ka histori ea bongaka le sebaka sa mahlaba a mahlaseli a molemo ho hlahloba li-cavitations tsa mohlahare. Leha ho le joalo, le hoja tse ling tsa liso tsena li baka bohloko, ho ruruha, bofubelu esita le feberu, tse ling ha li etse joalo. Kahoo, hangata ho hlokahala hore ho be le tekanyo e nepahetseng haholoanyane, e kang ho nka litšoantšo.

Li-Cavitations hangata ha li fumanoe lifiliming tsa radiographic tse tloaelehileng tsa mahlakore a mabeli (2-D) tse sebelisoang hangata ho phekola meno. Ratner le basebetsi-'moho le bona ba bontšitse hore 40% kapa ho feta ha lesapo le hloka ho fetoloa ho bontša liphetoho, 'me sena se tšehetsoa ke mosebetsi oa morao-rao,' me se bontšitsoe setšoantšong sa 2. Sena se amana le moeli oa tlhaho oa litšoantšo tsa 2-D tse bakang holimo. ea libopeho tsa anatomical, masking libaka tse thahasellisang. Tabeng ea mefokolo kapa pathology, haholo-holo ho mandible, phello ea masking ea lesapo le teteaneng la cortical holim'a mehaho e ka tlaase e ka ba ea bohlokoa. Ka hona, ho hlokahala mekhoa e tsoetseng pele ea theknoloji e kang CBCT, Tech 99 scans, magnetic resonance imaging (MRI), kapa trans-alveolar ultrasound sonography (CaviTAU™®) .

Har'a mekhoa e sa tšoaneng ea ho etsa litšoantšo e fumanehang, CBCT ke sesebelisoa sa ho hlahloba se sebelisoang ka ho fetisisa se sebelisoang ke lingaka tsa meno tse amehang ho hlahloba kapa ho phekola li-cavitations, ka hona ke eona eo re tla e tšohla ka botebo. Lejoe la motheo la theknoloji ea CBCT ke bokhoni ba eona ba ho bona leqeba la thahasello ka litekanyo tse 3 (ka pele, sagittal, coronal). CBCT e ipakile e le mokhoa o ka tšeptjoang le o nepahetseng oa ho khetholla le ho lekanya boholo le boholo ba bokooa ba ka har'a masapo a mohlahare ka ho sotha ho fokolang le ho holisa ho fokolang ho feta 2-D x-rays.

Setšoantšo sa 2 Tlhaloso: Ka lehlakoreng le letšehali ho bontšoa li-radiograph tsa 2-D tsa marapo a mohlahare a nkiloeng ho li-cadaver tse hlahang.

bophelo bo botle. Ka lehlakoreng le letona la setšoantšo ho na le linepe tsa masapo a mohlahare a tšoanang a bontšang necrotic cavitation e hlakileng.

Setšoantšo se nkiloe ho Bouquot, 2014.

Liphuputso tsa bongaka li bontšitse litšoantšo tsa CBCT li boetse li thusa ho fumana likahare tsa leqeba (li-fluid, granulomatous, solid, joalo-joalo), mohlomong li thusa ho khetholla pakeng tsa liso tsa ho ruruha, lihlahala tsa odontogenic kapa tse seng tsa odontogenic, cysts le tse ling tse kotsi kapa tse kotsi. diso .

Software e sa tsoa ntlafatsoa e kopantsoeng ka ho khetheha le mefuta e fapaneng ea lisebelisoa tsa CBCT e sebelisa likarolo tsa Hounsfield (HU) tse lumellang hore ho be le tlhahlobo e tloaelehileng ea ho teteka ha masapo. HU e emela sekhahla se lekanyelitsoeng sa lisele tsa 'mele ho latela sekala se lekantsoeng sa bohlooho-putsoa, ​​​​ho ipapisitse le boleng ba moea (-1000 HU), metsi (0 HU), le boima ba masapo (+1000 HU). Setšoantšo sa 3 se bontša maikutlo a fapaneng a setšoantšo sa kajeno sa CBCT.

Ho akaretsa, CBCT e ipakile e le molemo ho hlahlobisiseng le kalafong ea li-cavitations tsa mohlahare ka:

1. Ho khetholla boholo, boholo le boemo ba 3-D ba leqeba;
2. Ho tsebahatsa bohaufi ba leqeba ho likarolo tse ling tse haufi tsa bohlokoa tsa anatomical joalo ka

methapo e tlaase ea alveolar, maxillary sinus, kapa metso e haufi ea leino;

1. Ho khetholla mokhoa oa phekolo: ho buuoa khahlanong le ho se buuoe; le
2. Ho fana ka setšoantšo se latelang ho fumana hore na pholiso e kae le tlhoko e ka bang teng

ho phekola leqeba.

Setšoantšo sa 3 Ho hlaka ho ntlafala ha setšoantšo sa CBCT ka lebaka la theknoloji e hloekisitsoeng ea software, e fokotsang lintho tsa khale le "lerata" leo ho kenngoa ha meno le ho tsosolosoa ha tšepe ho ka bakang setšoantšong. Sena se nolofalletsa ngaka ea meno le mokuli hore ba bone leqeba leo habonolo. Karolo e ka holimo ke pono e ntle ea CBCT e bontšang sebaka se letšehali (#17) le se nepahetseng (#32) le boholo ba liso tsa cavitational ho mokuli oa mohlahare oa osteonecrosis. Karolo e ka tlase e ka letsohong le letšehali ke pono e saggital ea sebaka ka seng. Karolo e ka tlase e ka letsohong le letona ke 3-D e fanang ka sebaka sa #17 se bonts'ang cortical porosity overlying medullary cavitation. Ka tlhompho ea Dr. Reese.

Ultrasound

Re boetse re bua ka bokhutšoanyane mona sesebelisoa sa ultrasound, CaviTAU™®, se seng se entsoe mme se ntse se sebelisoa likarolong tsa Europe, ka ho khetheha bakeng sa ho lemoha libaka tse tlaase tsa masapo a ka holimo le a ka tlaase tse bontšang hore ho na le li-cavitations tsa mohlahare. Sesebelisoa sena sa trans-alveolar ultrasonic sonography (TAU-n) se ka 'na sa lekana ha se bapisoa le CBCT ka ho lemoha bokooa ba mohlahare,' me se na le molemo o eketsehileng oa ho pepesetsa mokuli mahlaseli a fokolang haholo . Sesebelisoa sena hajoale ha se fumanehe US empa se ntse se hlahlojoa ke US Food and Drug Administration mme e kanna ea ba sesebelisoa sa mantlha sa tlhahlobo se sebelisoang Amerika Leboea ho phekola CIMJD.

Li-Biomarker le Tlhahlobo ea Histological

Ka lebaka la tlhaho ea ho ruruha ha li-cavitations tsa mohlahare Lechner le Baehr, 2017 li batlisisitse kamano e ka bang teng pakeng tsa li-cytokine tse khethiloeng le lefu lena. cytokine e le 'ngoe e khahlang haholo ke 'e laoloang ha e kenya tšebetsong, T-cell e tloaelehileng e hlahisoang le ho patoa' (RANTES). Cytokine ena, hammoho le fibroblast growth factor (FGF) -2, e hlalosoa ka bongata bo bongata ka liso tsa cavitational le ho bakuli ba CIMDJ. Setšoantšo sa 4, se fanoeng ke Dr. Lechner, se bapisa maemo a RANTES ho bakuli ba nang le li-cavitations (bar e khubelu, ka ho le letšehali) le maemo a taolo ea bophelo bo botle (blue bar), e bontšang maemo a fetang makhetlo a 25 ho ba nang le lefu lena. Lechner et al o sebelisa mekhoa e 'meli ea ho lekanya maemo a cytokine. E 'ngoe ke ho lekanya maemo a li-cytokine ho tsoa maling (Diagnostic Solutions Laboratory, US.). Mokhoa oa bobeli ke oa ho nka biopsy ka ho toba ho tloha sebakeng se kulang ha e fihla ho hlahlojoa ke ngaka ea molomo. Ka bomalimabe, ka nako ena sampole ea lisele tsa lehae e hloka ts'ebetso e rarahaneng le thomello e ntseng e tla finyelloa litsing tseo e seng tsa lipatlisiso, empa e fane ka likamano tse nang le temohisiso.

Setšoantšo sa 4 Kabo ea RANTES maemong a 31 a FDOJ le disampole tse 19 tsa mohlahare o tloaelehileng ha ho bapisoa le x-ray density reference bakeng sa lihlopha ka bobeli libakeng tse tsamaellanang. Likhaloso: RANTES, e laoloang ha e sebelisoa, T-cell e tloaelehileng e hlalositsoeng le e patiloeng chemokine (CC motif) ligand 5; XrDn, X-ray density; FDOJ, mafura degenerative osteonecrosis ea mohlahare; n, palo; Ctrl, taolo. Setšoantšo se fanoeng ke Dr. Lechner. Nomoro ea laesense: CC KA-NC 3.0

Mehopolo e Tsoelang Pele bakeng sa ho hlahloba

Ho ba teng ha li-cavitations tsa mohlahare ho thehiloe hantle ka bongaka. Leha ho le joalo, litlhahlobo tse hlakileng le mekhoa e metle ea kalafo li hloka lipatlisiso tse ling. Re nahanne ka seo hoa hlokahala ho bolela ka bokhutšoanyane mekhoa e seng mekae e khahlang le e ka bang bohlokoa e sebelisoang ke litsebi tse ling.

Litšoantšo

Hoa hlokomeleha hore liteko tse eketsehileng tsa physiologic e ka ba sesebelisoa sa bohlokoa sa ho hlahloba le ho hlahloba. E 'ngoe ea lisebelisoa tse joalo tse sebelisoang ke lingaka tse ling ke litšoantšo tsa thermographic. Mosebetsi o tloaelehileng oa ho ruruha o ka bonoa ka ho lekanya phapang ea mocheso holim'a hlooho le molala. Thermography e bolokehile, e potlakile ebile e ka ba le boleng ba tlhahlobo bo ts'oanang le ba CBCT. Phello e kholo ke hore ha e na tlhaloso, e etsang hore ho be thata ho lemoha moeli kapa boholo ba leqeba.

Tlhahlobo ea Acupuncture Meridian

Litsebi tse ling li shebile boemo bo matla ba leqeba le sebelisang Acupuncture Meridian Assessment (AMA) ho fumana phello ea eona ho matla a eona a meridian. Mofuta ona oa tlhahlobo o thehiloe ho Electroacupuncture Ho latela Voll (EAV) . Mokhoa ona, o itšetlehileng ka meriana ea khale ea Sechaena le melao-motheo ea acupuncture, e ntlafalitsoe 'me e ntse e rutoa US. Acupuncture e 'nile ea sebelisoa ho kokobetsa bohloko le ho khothalletsa pholiso . E itšetlehile ka ho leka-lekana ha phallo ea matla (ke hore, Chi) ka litsela tse itseng tsa matla 'meleng. Litsela tsena, kapa li-meridians, li kopanya litho tse itseng, lisele, mesifa le masapo. Acupuncture e sebelisa lintlha tse tobileng ho meridian ho susumetsa bophelo bo botle le matla a likarolo tsohle tsa 'mele ho meridian eo. Mokhoa ona o ’nile oa sebelisoa ho senola lefu la mohlahare, leo ha le rarolloa, hape le phekolang mafu a bonahalang a sa amahane, a kang ramatiki kapa lefu la mokhathala o sa feleng . Mokhoa ona o etsa hore ho be le lipatlisiso tse tsoelang pele (ke hore, liphetho li hloka ho ngoloa, 'me data ea longitudinal e fumanoe le ho phatlalatsoa).

LINTLHA TSA BOHLOKOA

Ho na le lintlha tse ngata tsa motho ka mong tse eketsang kotsi bakeng sa nts'etsopele ea li-cavitations tsa mohlahare empa hangata kotsi ke lintho tse ngata. Likotsi ho motho e ka ba tšusumetso e ka ntle, joalo ka maemo a tikoloho kapa tšusumetso e ka hare, joalo ka ts'ebetso e mpe ea 'mele ea ho itšireletsa mafung. Lethathamo la 2 le la 3 le thathamisa mabaka a kotsi a ka ntle le a ka hare.

Hlokomela hore Lethathamo la 2, Lintho tse ka hare tsa Kotsi, ha li kenyelle liphatsa tsa lefutso. Leha ho ka nahanoa hore phapang ea liphatsa tsa lefutso e na le karolo, ha ho phapano e le 'ngoe ea liphatsa tsa lefutso kapa esita le motsoako oa liphatsa tsa lefutso tse bontšitsoeng e le sesosa sa kotsi, leha ho le joalo tšusumetso ea liphatsa tsa lefutso e ka etsahala. . Tlhahlobo e hlophisitsoeng ea lingoliloeng e entsoeng ka selemo sa 2019 e bonts'itse hore ho na le li-nucleotide polymorphisms tse 'maloa tse fumanoeng, empa ha ho na boikaketsi lithutong tsohle. Bangoli ba ile ba etsa qeto ea hore ho fanoe ka mefuta-futa ea liphatsa tsa lefutso tse bontšitseng litloaelano tse ntle le li-cavitations le ho haelloa ke ho ikatisa ha lithuto, karolo e bapaloang ke liphatsa tsa lefutso e tla bonahala e le e itekanetseng le e fapaneng. Leha ho le joalo, ho ka ’na ha hlokahala hore ho shejoe batho ba itseng ka ho khetheha ho khetholle liphapano tsa lefutso . Ha e le hantle, joalokaha ho bontšitsoe, e 'ngoe ea mekhoa e tloaelehileng le ea motheo ea pathophysiologic ea tšenyo ea masapo a ischemic ke ho koala ho feteletseng ho tloha linaheng tsa hypercoagulation, tseo hangata li nang le liphatsa tsa lefutso, joalokaha ho hlalositsoe ke Bouquot and Lamarche (1999) . Letlapa la 4 le fanoeng ke Dr. Bouquot, le thathamisa lefu lena le bolela hore ho na le hypercoagulation le lirapa tse latelang tsa 3 li fana ka kakaretso ea tse ling tsa liphuputso tsa Dr. Bouquot tseo a li hlahisitseng mosebetsing oa hae e le Mookameli oa Lipatlisiso Setsing sa Maxillofacial sa Thuto le Lipatlisiso.

Li-cavitations tsa mohlahare ho na le bopaki bo hlakileng ba ischemic osteonecrosis, e leng lefu la masapo moo lesapo le fetohang necrotic ka lebaka la ho haelloa ke oksijene le limatlafatsi. Joalokaha ho boletsoe, lintlha tse ngata li ka sebelisana ho hlahisa li-cavitations 'me ho fihlela ho 80% ea bakuli ba na le bothata, hangata bo futsitsoeng, ba tlhahiso e feteletseng ea ho thibela mali methapong ea bona ea mali. Hangata lefu lena ha le senoloe nakong ea liteko tsa kamehla tsa mali. Lesapo le hlaseloa haholo ke bothata bona ba hypercoagulation mme le hlahisa methapo ea mali e atolositsoeng haholo; ho eketseha, hangata ho bohloko, khatello ea ka hare; ho thekesela ha mali; esita le infarctions. Bothata bona ba hypercoagulation bo ka 'na ba hlahisoa ke histori ea lelapa ea lefu la stroke le lefu la pelo a sa le monyenyane (ka tlaase ho lilemo tse 55), phetoho ea letheka kapa "ramatiki" (haholo-holo a sa le monyenyane), osteonecrosis (haholo-holo a sa le monyenyane), e tebileng. thrombosis ea methapo, pulmonary emboli (matšelo a mali matšoafong), thrombosis ea mothapo oa retina (matšelo a retina ea leihlo) le ho senyeheloa ke mpa khafetsa. Mehlahare e na le mathata a khethehileng a 2 ka lefu lena: 1) hang ha e senyehile, lesapo le kulang le sitoa ho mamella tšoaetso ea boemo bo tlaase ho tsoa ho libaktheria tsa meno le marenene; le 2) lesapo le ka 'na la se ke la hlaphoheloa ho fokotseha ha phallo ea mali e bakoang ke lithethefatsi tsa sebakeng seo tse sebelisoang ke lingaka tsa meno nakong ea mosebetsi oa meno. Setšoantšo sa 5 se fana ka pono ea microscopic ea intravascular thrombus.

Lethathamo 4 Mafu a bolela hore a kenyelletsa hypercoagulation. Bakuli ba bane ho ba bahlano ba jawbone cavitation ba na le e 'ngoe ea tsena tse koalang

ntlha mathata.

Ho sa tsotellehe hore na sesosa se ka sehloohong sa hypercoagulation ke sefe, lesapo le hlahisa motsoako oa fibrous (li-fibers li ka phela libakeng tse nang le tlala ea limatlafatsi), 'mala o mafura, o shoeleng ("wet rot"), o omme haholo, ka linako tse ling o le letlalo ("o omileng" ), kapa sebaka se se nang letho sa moko ("cavitation").

Lesapo leha e le lefe le ka ameha, empa letheka, mangole le mehlahare hangata li ameha. Hangata bohloko bo matla empa bo ka ba 1/3^rd ea bakuli ha ba utloe bohloko. 'Mele o na le bothata ba ho ipholisa lefung lena le 2/3^likhahla maemong a itseng ho hlokahala hore ho tlosoe moko o senyehileng ka ho buuoa, hangata ka ho hohloa ka li-curettes. Ho buuoa ho tla felisa bothata (le bohloko) hoo e ka bang 3/4^tse ea bakuli ba nang le karolo ea mohlahare, le hoja ho buuoa ka makhetlo a mangata, hangata mekhoa e menyenyane ho feta ea pele, e hlokoa ho 40% ea bakuli, ka linako tse ling likarolong tse ling tsa mehlahare, hobane lefu lena le atisa ho ba le liso tsa "skip" (ke hore, libaka tse ngata sebakeng sa marang-rang). masapo a ts'oanang kapa a ts'oanang joalo), ka moko oa tloaelehileng lipakeng. Ho feta halofo ea bakuli ba letheka qetellong ba tla fumana lefu lena ka letheka le fapaneng. Ho feta 1/3^rd bakuli ba mohlahare ba tla fumana lefu lena likarolong tse ling tsa mohlahare. Haufinyane tjena, ho fumanoe hore 40% ea bakuli ba nang le osteonecrosis ea letheka kapa mohlahare ba tla arabela anticoagulation ka heparin e tlaase ea molek'hule (Lovenox) kapa Coumadin ka tharollo ea bohloko le ka ho folisa masapo.

Setšoantšo sa 5 Pono ea microscopic ea intravascular thrombi

Haeba ho batla mokhoa o seng oa meriana bakeng sa ho fokotsa kotsi ea hypercoagulation motho a ka nahana ka tšebeliso ea li-enzyme tsa tlatsetso tse kang nattokinase kapa lumbrokinase e matla ka bobeli e nang le thepa ea fibrinolytic le anticoagulation. Ho phaella moo, ho haella ha koporo ho bolela, tse amanang le ho se sebetse ha coagulation, li lokela ho tlosoa ka lebaka la kotsi e eketsehileng ea hypercoagulation e hlokometsoeng ho bakuli ba nang le li-cavitations tsa mohlahare.

LITŠOANTŠISO TSA TSAMAISO LE TŠEBELETSO

Boteng ba li-cavitations tsa mohlahare le lefu la bona le amanang le tsona li kenyelletsa matšoao a itseng, empa hangata li kenyelletsa matšoao a mang a sa tobang a tsamaiso. Ka hona, tlhahlobo ea eona le kalafo li lokela ho atameloa ka hloko ka botlalo ke sehlopha sa tlhokomelo. Lintlha tse ikhethang ka ho fetisisa le tse senyang maikutlo tse hlahileng ho tloha pampiri ea boemo ba IAOMT 2014 ke qeto ea maemo a sa foleng a sa foleng a bonahalang a sa amaneng ka mor'a phekolo ea cavitation. Ho sa tsotellehe hore na mafu a tsamaiso ea 'mele ke a autoimmune kapa ho ruruha ho etsahala ka tsela e fapaneng, ho tlalehiloe lintlafatso tse kholo, ho kenyelletsa le ntlafatso ea kankere. Matšoao a rarahaneng a amanang le liso tsena ke motho ka mong haholo 'me ka hona ha a tloaelehe kapa ha a hlokomelehe habonolo. Ka hona, IAOMT e na le maikutlo a hore ha mokuli a fumanoa a e-na le li-jawbone cavitations tse nang le bohloko ba sebakeng seo kapa ntle le bohloko bo amanang le sebaka seo, hape a e-na le boloetse bo bong ba tsamaiso pele ho moo ho neng ho sa boleloa hore ke li-jawbone cavitations, mokuli o hloka tlhahlobo e eketsehileng ho fumana hore na boloetse bo amana le , kapa ke phello ea lefu lena. IAOMT e ile ea hlahloba litho tsa eona ho ithuta ho eketsehileng ka hore na matšoao a tsamaiso / mafu a rarolla joang ka mor'a ho buuoa ka cavitational. Liphetho li hlahisoa ho Sehlomathiso sa I.

Ho ba teng ha li-cytokine tse hlahisitsoeng ka mokhoa o fokolang oa vascularized, necrotic liso tsa jawbone cavitations li bonahala li sebetsa e le sepheo sa li-cytokine tse ruruhileng tse bolokang libaka tse ling tsa ho ruruha ho sebetsa le / kapa ho sa foleng. Phomolo kapa bonyane ntlafatso ho tsoa ho bohloko ba mohlahare o latelang kalafo e lebelletsoe ebile e lebelletsoe, empa khopolo ena e tsepameng ea ho ruruha, e tla tšohloa ka botlalo ka tlase, e ka hlalosa hore na ke hobane'ng ha mafu a mangata a bonahalang a sa amane 'me a amahanngoa le maemo a sa foleng a ho ruruha. li boetse li fokotsehile ka kalafo ea cavitation.

Ho tšehetsa liqeto tse entsoeng pampiring ea boemo ba IAOMT ea 2014 e hokahanyang li-cavitations tsa mohlahare le maloetse a tsamaiso, lipatlisiso le lithuto tsa bongaka tse sa tsoa hatisoa ke Lechner, von Baehr le ba bang, li bontša hore liso tsa jawbone cavitation li na le profil e itseng ea cytokine e sa bonahaleng mafung a mang a masapo. . Ha ho bapisoa le mehlala ea mohlahare o phetseng hantle, li-pathologies tsa cavitation li tsoela pele ho bontša ho phahama ho matla ha fibroblast growth factor (FGF-2), Interleukin 1 receptor antagonist (Il-1ra), 'me, ka ho khetheha, RANTES. RANTES, e tsejoang hape e le CCL5 (cc motif Ligand 5) e hlalositsoe e le chemotactic cytokine e nang le ketso e matla ea ho ruruha. Li-chemokine tsena li bontšitsoe ho kena-kenana le mekhahlelo e mengata ea karabelo ea 'mele ea ho itšireletsa mafung' me li ameha haholo maemong a fapaneng a mafu le tšoaetso. Liphuputso li bontšitse hore RANTES e ameha mafung a mangata a tsamaiso a kang ramatiki, lefu la mokhathala o sa foleng, atopic dermatitis, nephritis, colitis, alopecia, mafu a qoqotho le ho khothalletsa multiple sclerosis le Parkinson's disease . Ho feta moo, RANTES e bonts'itsoe e baka ho potlakisa ho hola ha hlahala.

Lintlha tsa kholo ea fibroblast le tsona li kentse letsoho ho li-cavitations tsa mohlahare. Lintlha tsa kholo ea Fibroblast, FGF-2, le li-receptor tse amanang le tsona, li ikarabella bakeng sa mesebetsi e mengata ea bohlokoa, ho kenyelletsa ho ata ha lisele, ho phela le ho falla. Ba boetse ba kotsing ea ho koeteloa ke lisele tsa mofetše le ho bapala karolo ea oncogenic ho mefuta e mengata ea mofetše. Ka mohlala, FGF-2 e khothalletsa tsoelo-pele ea hlahala le kankere ho kankere ea senya. Ntle le moo, maemo a FGF-2 a bonts'itse kamano e tobileng le tsoelo-pele, metastasis le bofokoli ba ho pholoha ho bakuli ba mofetše oa colorectal. Ha ho bapisoa le taolo e se nang mofetše, bakuli ba nang le kankere ea mala ba na le maemo a phahameng haholo a FGF-2 serum ea bona. Manqosa ana a ho ruruha a 'nile a ameha mafung a mangata a tebileng ebang ke a tlhaho ea ho ruruha kapa kankere. Ho fapana le RANTES / CCL5 le FGF-2, IL1-ra e bontšitsoe hore e sebetsa e le mokena-lipakeng ea matla ea khahlanong le ho ruruha, e leng se tlatsetsang ho hlokeng matšoao a tloaelehileng a ho ruruha ka har'a liso tse ling tsa cavitation.

Maemo a feteletseng a RANTES le FGF-2 ho liso tsa cavitation a bapisitsoe mme a amahanngoa le maemo a hlokometsoeng mafung a mang a tsamaiso joaloka amyotrophic lateral sclerosis, (ALS) multiple sclerosis (MS), ramatiki ea ramatiki le kankere ea matsoele. Ka 'nete, maemo a manqosa ana a fumanoeng ka har'a li-cavitations tsa mohlahare a phahame ho feta serum le cerebrospinal fluid ea bakuli ba ALS le MS. Lipatlisiso tsa morao-rao tse entsoeng ke Lechner le von Baehr li bonts'itse keketseho ea makhetlo a 26 ho RANTES ka har'a lesapo la osteonecrotic ea mohlahare oa bakuli ba mofetše oa matsoele. Lechner le basebetsi-'moho ba fana ka maikutlo a hore cavitation e nkiloeng RANTES e ka sebetsa e le potlakisang ea tsoelo-pele ea kankere ea matsoele.

Joalokaha ho boletsoe pejana, ho na le linyeoe tse ngata tsa asymptomatic jawbone cavitations. Maemong ana, li-cytokine tse matla tsa pro-inflammatory tse kang TNF-alpha le IL-6, ha li bonoe ka lipalo tse eketsehileng liphuputsong tsa pathohistological tsa lisampole tsa cavitation. Ho bakuli bana, ho ba sieo ha li-cytokine tsena tsa pro-inflammatory ho amahanngoa le maemo a phahameng a anti-inflammatory cytokine Interleukin 1-receptor antagonist (Il-1ra). Qeto e utloahalang ke hore ho ruruha ho matla ho amanang le li-jawbone cavitations ho tlas'a taolo ea maemo a phahameng a RANTES / FGF-2. Ka lebaka leo, ho etsa tlhahlobo, Lechner le von Baehr ba fana ka maikutlo a ho fokotsa ho tsepamisa maikutlo ho ba teng ha ho ruruha le ho nahana ka tsela ea pontšo, haholo-holo ka ho feta ho hlahisa RANTES/FGF-2. Maemo a phahameng a RANTES / FGF-2 ho bakuli ba cavitation a bontša hore lisosa tsena li ka 'na tsa baka tsela e tšoanang le e matlafatsang ka mokhoa o ts'oanang le ho matlafatsa litsela tsa matšoao a pathogenic ho litho tse ling. Tsamaiso ea 'mele ea ho itšireletsa mafung e sebetsa ka lebaka la matšoao a kotsi, a hlahisang litsela tse sa tšoaneng tsa tlhaho tsa molek'hule tse qetellang ka tlhahiso ea cytokine ea ho ruruha le ts'ebetso e ka khonehang ea tsamaiso ea' mele ea ho itšireletsa mafung. Sena se tšehetsa khopolo le khopolo ea hore li-cavitations tsa mohlahare li ka sebetsa e le sesosa sa mantlha sa mafu a sa foleng a sa foleng ka tlhahiso ea RANTES/FGF-2 'me e hlalosa ka ho eketsehileng hore na ke hobane'ng ha matšoao a matla a ho ruruha a sa bonoe kapa a utloahala ke mokuli ka liso tsa mohlahare. bona. Ka hona, li-cavitations tsa mohlahare le manģosa ana a amehang a emela karolo e kopanetsoeng ea lefu la ho ruruha 'me e sebetsa e le sesosa se ka sehloohong sa lefu lena. Ho tlosa li-cavitations e ka ba senotlolo sa ho khutlisa mafu a ho ruruha. Sena se tšehetsoa ke tlhokomelo ea ho fokotseha ha maemo a RANTES ka mor'a ho buuoa ka mor'a ho buuoa ho bakuli ba 5 ba kankere ea matsoele (Bona Letlapa la 5). Lipatlisiso le liteko tse ling tsa maemo a RANTES/CCL5 li ka fana ka temohisiso kamanong ena. Maikutlo a khothatsang ke ntlafatso ea boleng ba bophelo bo hlokometsoeng ke bakuli ba bangata ba jawbone cavitation, ebang ke ho imolla sebakeng sa ts'ebetso kapa ho fokotseha ha ho ruruha ho sa foleng kapa maloetse libakeng tse ling.

Lethathamo 5

Phokotso (Bokhubelu) ho RANTES / CCL5 ka serum ho bakuli ba kankere ea matsoele ba 5 ba ileng ba etsoa opereishene bakeng sa mafura-degenerative osteonecrosis ea mohlahare (FDOJ). Tafole e ikamahanyang le

Lechner et al, 2021. Jawbone Cavitation e Hlalositsoe RANTES/CCL5: Lithuto Tsa Litaba Tse Kopanyang Ho Ruruha ho Khutsitseng Mohlahareng le Epistemology ea Kankere ea Matsoele.” Kankere ea Matsoele: Lipheo le Phekolo.

Mekhoa ea Kalafo

Ka lebaka la ho haella ha lingoliloeng tse mabapi le phekolo ea li-cavitational liso, IAOMT e ile ea hlahloba litho tsa eona ho bokella tlhahisoleseding mabapi le hore na ke mekhoa efe le mekhoa ea phekolo e ntseng e tsoela pele ho ea ho 'tekanyetso ea tlhokomelo'. Liphetho tsa phuputso li tšohloa hakhutšoanyane ho Sehlomathiso sa II.

Hang ha sebaka le boholo ba liso li khethiloe, mekhoa ea phekolo e hlokahalang. IAOMT ke ea kelello ea hore ka kakaretso ha e amohelehe ho tlohela "lesapo le shoeleng" 'meleng oa motho. Sena se ipapisitse le lintlha tse fanang ka maikutlo a hore li-cavitations tsa mohlahare e ka ba tsona tse lebisang tlhokomelo ho systemic cytokines le endotoxins ho qala ts'ebetso ea ho theola bophelo bo botle ba mokuli ka kakaretso.

Tlas'a maemo a loketseng, biopsy e lokela ho etsoa ho netefatsa tlhahlobo ea lefu la mohlahare ofe kapa ofe le ho thibela mafu a mang. Joale, phekolo ea ho tlosa kapa ho felisa lefu le amehang le ho susumetsa ho hōla ha lesapo le tloaelehileng, la bohlokoa lea hlokahala. Nakong ena libukeng tse hlahlojoang ke lithaka, phekolo ea ho buoa e akarelletsang ho ntša lesapo le amehileng leo e seng la bohlokoa e bonahala e le phekolo e ratoang bakeng sa li-cavitations tsa mohlahare. Kalafo e akarelletsa tšebeliso ea meriana e thethefatsang sebakeng seo, e leng se lebisang tlhokomelong ea bohlokoa. Pele ho ne ho nahanoa hore epinephrine e nang le meriana e thethefatsang, e tsebang thepa ea vasoconstrictive, e lokela ho qojoa ho bakuli bao e ka 'nang eaba ba se ba sekisitse phallo ea mali e amanang le boemo ba bona ba lefu. Leha ho le joalo, letotong la lithuto tsa limolek'hule, phapang ea osteoblastic e ile ea eketseha ka tšebeliso ea epinephrine. Ka hona, ngaka e tlameha ho etsa qeto ea hore na e tla sebelisa epinephrine joang 'me haeba ho joalo, chelete e lokelang ho sebelisoa e tla fana ka liphello tse molemo ka ho fetisisa.

Ka mor'a ho khabisoa ka ho buuoa le ho phekoloa ka ho feletseng ha leqeba le ho nosetsa ka letsoai le tloaelehileng le sa hloekang, pholiso e matlafatsoa ke ho kenngoa ha li-fibrin tse nang le platelet-rich fibrin (PRF) sebakeng se osseous . Tšebeliso ea li-platelet-rich fibrin e tsepamisitse maikutlo lits'ebetsong tsa ho buuoa ha e na molemo feela ho tloha ponong ea ho koala, empa hape ho tloha karolong ea ho lokolla lintlha tsa kholo ka nako e fihlang ho matsatsi a leshome le metso e mene ka mor'a ho buuoa . Pele ho sebelisoa li-grafts tsa PRF le liphekolo tse ling tse tlatsetsang, ho khutlela morao ha lesapo la mohlahare oa osteonecrotic ka mor'a ho buuoa ho etsahetse hoo e ka bang 40% ea linyeoe.

Ho shebisisa mabaka a kotsi a kantle a boletsoeng ho Lethathamo la 2 ho fana ka maikutlo a matla a hore liphetho tse sa thabiseng li ka qojoa ka mokhoa o nepahetseng oa ho buoa le ho sebelisana le ngaka / mokuli, haholo-holo har'a batho ba kotsing. Ho eletsoa ho nahana ka ho sebelisa mekhoa ea atraumatic, ho fokotsa kapa ho thibela mafu a periodontal le a mang a meno, le ho khetha setsi sa ntoa se tla lumella liphello tse molemo ka ho fetisisa tsa pholiso. Ho fana ka litaelo tse felletseng ho mokuli pele le ka morao ho ts'ebetso, ho kenyelletsa le likotsi tse amanang le ho tsuba lisakerete ho ka thusa ho fokotsa liphello tse mpe.

Ha u ntse u hopola lethathamo le pharaletseng la lintho tse ka 'nang tsa e-ba kotsi tse thathamisitsoeng ho Lethathamo la 2 le la 3, lipuisano le sehlopha sa tlhokomelo e atolositsoeng ea mokuli ho khothalletsoa ho netefatsa ka nepo mabaka a kotsi a patiloeng a ka tlatsetsang ho nts'etsopele ea li-cavitations tsa mohlahare. Ka mohlala, taba ea bohlokoa ha ho phekoloa li-cavitations tsa mohlahare ke hore na motho o noa li-antidepressants, ka ho khetheha khetha serotonin reuptake inhibitors (SSRIs). Li-SSRI li 'nile tsa amahanngoa le ho fokotseha ha masapo le ho eketseha ha sekhahla sa ho robeha. SSRI Fluoxetine (Prozac) e thibela ka ho toba phapang ea osteoblast le mineralization. Bonyane liphuputso tse peli tse ikemetseng tse hlahlobang basebelisi ba SSRI ha li bapisoa le litaolo li bonts'itse hore ts'ebeliso ea SRRI e amahanngoa le li-indices tse mpe tsa panoramic morphometric.

Preconditioning e ka boela ea tlatsetsa liphellong tse atlehileng tsa phekolo. Sena se kenyelletsa ho theha tikoloho ea 'mele e loketseng pholiso ka ho fa' mele maemo a lekaneng a limatlafatsi tse nepahetseng tse ntlafatsang sebaka sa tlhaho ka ho ntlafatsa homeostasis 'meleng. Maqheka a preconditioning hase kamehla a ka khonehang, kapa a amoheleha ho mokuli, empa a bohlokoa haholo ho bakuli ba tsebang lintho tseo ba nang le tsona, tse kang ba nang le liphatsa tsa lefutso, mathata a ho folisa kapa bophelo bo botle. Maemong a joalo, ho bohlokoa hore ntlafatso ena e etsahale ho fokotsa maemo a khatello ea oxidative, e ke keng ea tsosa feela ts'ebetso ea lefu lena empa e ka kena-kenana le pholiso e lakatsehang.

Ka mokhoa o nepahetseng, phokotso ea moroalo ofe kapa ofe o chefo 'meleng o kang fluoride le/kapa mercury ho tsoa ho li-amalgam tsa meno li lokela ho phethoa pele ho phekoloa li-cavitations tsa mohlahare. Mercury e ka tlosa tšepe sebakeng sa ketane ea lipalangoang ea elektronike ea mitochondria. Sena se fella ka tšepe e sa lefelloeng e feteletseng (tšepe ea tšepe kapa Fe ++), e hlahisang mefuta e senyang ea oksijene e sebetsang (ROS) e tsejoang hape e le li-radicals tsa mahala, tse bakang khatello ea oxidative. Tšepe e feteletseng liseleng tsa masapo e boetse e thibela tšebetso e nepahetseng ea li-osteoblasts, tseo ka ho hlakileng li tla ba le phello e mpe ha li leka ho folisa lefu la masapo .

Mefokolo e meng le eona e lokela ho rarolloa pele ho kalafo. Ha ho na le khaello ea bioavailable koporo, magnesium le retinol, metabolism le recycling ea tšepe e ba dysregulated 'meleng, e leng se tlatsetsang ho feteletseng mahala tšepe libakeng tse fosahetseng e lebisang ho khatello ea kelello le ho feta oxidative le kotsi ea mafu. Haholo-holo, li-enzyme tse ngata 'meleng (tse kang ceruloplasmin) li fetoha tse sa sebetseng ha ho se na maemo a lekaneng a koporo, magnesium le retinol, e leng se etsang hore ho be le tsamaiso ea tsamaiso ea tšepe le ho eketseha ha khatello ea oxidative le kotsi ea mafu.

Mekhoa e meng ea Kalafo

Mekhoa e meng e sebelisoang e le phekolo ea mantlha kapa e tšehetsang le eona e lokela ho hlahlojoa. Tsena li kenyelletsa homeopathy, ts'usumetso ea motlakase, kalafo e bobebe joalo ka photobiomodulation, le laser, boemo ba bongaka ba oksijene / ozone, oksijene ea hyperbaric, mekhoa ea anticoagulation, litlhare tsa Sanum, phepo e nepahetseng le phepo e nepahetseng, sauna ea infra-red, phekolo ea ozone e kenang methapong, kalafo ea matla, le tse ling. Ka nako ena, saense ha e so etsoa e ka tiisang hore mefuta ena ea phekolo e ka sebetsa kapa ha e sebetse. Ho lokela ho thehoe litekanyetso tsa tlhokomelo ho netefatsa pholiso e nepahetseng le detoxification. Mekhoa ea ho lekanya katleho e lokela ho lekoa le ho ba le maemo. Melao-motheo kapa mekhoa ea ho thusa ho fumana hore na phekolo e loketse neng le hore na ha e ea lokela ho hlahisoa bakeng sa tlhahlobo.

CONCLUSIONS

Lipatlisiso li bontšitse hore ho ba teng ha li-jawbone cavitations ke mokhoa o bolotsana oa lefu le amanang le ho fokotseha ha phallo ea mali . Phallo ea mali e senyehileng ea medulla e lebisa ho se nang liminerale le ho se lekane ha vascularization libakeng tsa mohlahare o ka tšoaetsoang ke likokoana-hloko, ho matlafatsa lefu la lisele. Ho phalla ha mali ka botsoa ka har'a liso tsa cavitational ho phephetsa ho fana ka lithibela-mafu, limatlafatsi le manģosa a 'mele oa ho itšireletsa mafung. Tikoloho ea ischemic le eona e ka ts'oara le ho khothaletsa bakena-lipakeng ba sa foleng ba ka bang le litlamorao tse mpe le ho feta ho bophelo bo botle ba sistimi. Boemo ba liphatsa tsa lefutso, ho fokotseha ha tšebetso ea 'mele ea ho itšireletsa mafung, liphello tsa meriana e itseng, ho sithabela maikutlo le tšoaetso, le lintlha tse ling tse kang ho tsuba li ka susumetsa kapa tsa potlakisa ho hōla ha masapo a mohlahare .

Hammoho le setsebi se tummeng sa mafu a mohlahare, Dr. Jerry Bouquot, IAOMT e hlahisa le ho khothalletsa boitsebiso bo nepahetseng ba histologically le pathologically of jawbone cavitational diso as Chronic Ischemic Medullary Disease of the Jawbone, CIMDJ. Le hoja mabitso a mangata, li-acronyms, le mantsoe a na le histori 'me a ntse a sebelisoa ho hlalosa lefu lena, IAOMT e kholisehile hore ena ke lentsoe le nepahetseng ka ho fetisisa la ho hlalosa boemo ba pathologic le micro-histologic hangata bo fumanoang ho jawbone cavitations.

Le hoja maqeba a mangata a mohlahare oa cavitational a thatafalloa ke ho hlahloba li-radiographs tse tloaelehileng 'me boholo ba tsona ha bo utloise bohloko, motho ha aa lokela ho nahana hore mokhoa oa lefu lena ha o eo. Ho na le mekhoa e mengata ea maloetse eo ho leng thata ho e tseba, le e mengata e seng bohloko. Haeba re ne re sebelisa bohloko e le sesupo sa kalafo, lefu la periodontal, lefu la tsoekere le boholo ba mofets'e li ne li ke ke tsa phekoloa. Kajeno ngaka ea meno e na le mefuta e mengata ea mekhoa ea ho phekola ka katleho li-cavitations tsa mohlahare le ho hloleha ho amohela lefu lena le ho khothaletsa phekolo e seng e tebileng ho feta ho hlōleha ho hlahloba le ho phekola lefu la periodontal. Bakeng sa bophelo bo botle le bophelo bo botle ba bakuli ba rona, phetoho ea paradigm ke ea bohlokoa ho litsebi tsohle tsa tlhokomelo ea bophelo, ho kenyelletsa le lingaka tsa meno le tsa bongaka, ho 1) ho lemoha ho ata ha li-cavitations tsa mohlahare le 2) ho amohela kamano pakeng tsa li-cavitations tsa mohlahare le lefu la tsamaiso.

SEHLOMATHISO I

IAOMT SURVEY 2 RESULTS (2023)

Joalokaha ho boletsoe ka bokhutšoanyane pampiring, maemo a sa amaneng a atisa ho khutla ka mor'a ho buuoa ka cavitation. Ho ithuta ho eketsehileng ka hore na ke mefuta efe ea maemo a rarollang le hore na ho fokotseha ha nako e telele ho etsahala joang mabapi le ho buuoa, tlhahlobo ea bobeli e ile ea romeloa ho litho tsa IAOMT. Lethathamo la matšoao le maemo ao litho tsa komiti ena li hlokometseng hore li ntlafala ka mor’a hore ho buuoe ho hlophisitsoe bakeng sa phuputso. Ba arabelang ba ile ba botsoa hore na ba kile ba bona leha e le efe ea maemo ana a imoloha ka mor'a ho buuoa, 'me haeba ho joalo ka tekanyo e kae. Ba boetse ba botsoa hore na matšoao a fola kapele kapa haeba ntlafatso e nka nako e telele ho feta likhoeli tse peli. Ho feta moo, ba arabetseng ba ile ba botsoa hore na ba tloaetse ho etsa opereishene sebakeng sa motho ka mong, libakeng tse ngata tse fapaneng, kapa libakeng tsohle ts'ebetsong e le 'ngoe. Liphetho tsa lipatlisiso li hlahisoa ho Lipalo tse ka tlase. Lintlha ke tsa pele, kaha palo ea ba arabelitsoeng e ne e le nyane (33) le hore ho na le lintlha tse sieo.

Appx I ea 1 Ba arabelang ba fane ka lintlha tsa ntlafatso (e bonolo, e itekanetseng kapa ea bohlokoa) 'me ba hlokomela hore na ntlafatso e etsahetse ka potlako (likhoeli tse 0-2) kapa e nkile nako e telele (> likhoeli tse 2). Maemo/matšoao a thathamisitsoe ho latela tatellano ea tse tlalehiloeng ka bongata. Hlokomela hore maemo a mangata/matšoao a tlositsoe ka nako e ka tlase ho likhoeli tse peli (lehlakoreng le letšehali la moeli oa bohareng).

Appx I ea 2 Joalokaha ho bontšitsoe ka holimo, maemong a mangata, ba arabelang ha baa ka ba hlokomela nako ea ho hlaphoheloa bakeng sa ntlafatso e hlokometsoeng.

Appx I ea 3 Ba arabelang ba arabile potso, "Na ka tloaelo ua khothaletsa/oa sebetsa

ho buuoa bakeng sa libaka tsa batho ka bomong, libaka tse ka thōko tse tšoaroang hammoho, kapa libaka tsohle tse phekoloang ka opereishene e le ’ngoe?”

SEHLOMATHISO II

IAOMT SURVEY 1 RESULTS (2021)

Ka lebaka la khaello ea lingoliloeng le litlhahlobo tsa linyeoe tsa kliniki tse amanang le phekolo ea li-cavitational liso, IAOMT e ile ea hlahloba litho tsa eona ho bokella tlhahisoleseding mabapi le hore na ke mekhoa efe le mekhoa ea phekolo e ntseng e tsoela pele ho ea ho 'tekanyetso ea tlhokomelo'. Phuputso e felletseng e fumaneha webosaeteng ea IAOMT (hlokomela hore ha se basebetsi bohle ba arabileng lipotso tsohle tsa lipatlisiso).

Ho akaretsa ka bokhuts'oane, boholo ba ba arabelitsoeng ba 79 ba fana ka kalafo ea opereishene, e kenyelletsang ponahatso ea lisele tse bonolo, phihlello ea opereishene ea sebaka sa cavitation, le mekhoa e fapaneng ea 'ho hloekisa' 'mele le ho bolaea likokoana-hloko sebakeng se amehileng. Mefuta e mengata ea meriana, li-nutraceuticals, le / kapa lihlahisoa tsa mali li sebelisoa ho khothalletsa pholiso ea leqeba pele ho koala lesela le bonolo.

Hangata li-rotary burs li sebelisoa ho bula kapa ho fihlella lesapo la masapo. Bongata ba lingaka ba sebelisa sesebelisoa sa letsoho ho folisa kapa ho hohola lesapo le kulang (68%), empa mekhoa le lisebelisoa tse ling li boetse li sebelisoa, joalo ka rotary bur (40%), piezoelectric (ultrasonic) instrument (35%) kapa ER:YAG laser (36%), e leng maqhubu a laser a sebelisetsoang ho phalla ha photoacoustic .

Hang ha setša se hloekisitsoe, se silafalitsoe, le/kapa se phekotsoe, boholo ba ba arabelitsoeng ba sebelisa metsi a ozone ho bolaea likokoana-hloko le ho khothalletsa pholiso. 86% ea ba arabelitsoeng ba sebelisa PRF (platelet-rich fibrin), PRP (platelet-rich plasma) kapa ozonated PRF kapa PRP. Mokhoa o ts'episang oa ho bolaea likokoana-hloko o tlalehiloeng libukeng le ka har'a phuputso ena (42%) ke ts'ebeliso ea Er:YAG. 32% ea ba arabelitsoeng ha ba sebelise mofuta leha e le ofe oa lesapo ho tlatsa sebaka sa cavitation.

Bongata ba ba arabetseng (59%) hangata ha ba hlahlobe maqeba a hlalosang mabaka a fapaneng a theko, ho se khone ho fumana lisampole tse sebetsang, bothata ba ho fumana lab ea mafu, kapa bonnete ba boemo ba lefu lena.

Bongata ba ba arabelitsoeng ha ba sebelise lithibela-mafu pele ho ts'ebetso (79%), nakong ea ho buuoa (95%) kapa ka mor'a ho buuoa (69%). Tšehetso e 'ngoe ea IV e sebelisoang e kenyelletsa dexamethasone steroids (8%) le Vithamine C (48%). Batho ba bangata ba arabetseng (52%) ba sebelisa poso ea boemo bo tlase ea laser therapy (LLLT) molemong oa ho folisa. Batho ba bangata ba arabelitsoeng ba khothaletsa tšehetso ea limatlafatsi tse kenyelletsang livithamini, liminerale, le homeopathics tse fapaneng pele ho (81%) le nakong ea (93%) ea nako ea pholiso.

SEHLOMATHISO III

Images

Appx III setšoantšo sa 1 Phanele e ka ho le letšehali: tlhahlobo ea X-ray ea 2D sebakeng sa #38. Phanele e ka ho le letona: Litokomane tsa sepakapaka sa FDO) sebakeng sa retromolar 38/39 ho sebelisoa motsoako o fapaneng ka mor'a opereishene ea FDOJ.

Likhaloso: FDOJ, mafura degenerative osteonecrosis ea mohlahare.

E hlophisitsoe ho tsoa ho Lechner, et al, 2021. "Jawbone Cavitation E Hlahisitsoe RANTES/CCL5: Lithuto Tsa Litaba Tse Kopantseng Ho ruruha ho Khutsitseng ka Mohlahare le Epistemology ea Kankere ea Matsoele." Kankere ea Matsoele: Lipheo le Phekolo

Appx 3 ea 2 Papiso ea li-cytokine tse supileng (FGF-2, IL-1ra, IL-6, IL-8, MCP-1, TNF-a le RANTES) ho FDOJ ka tlas'a RFT #47 le li-cytokines ka har'a mohlahare o phetseng hantle (n = 19). Litokomane tsa Intraoperative tsa katoloso ea FDOJ ka lesapong le letona le ka tlase la mohlahare, sebakeng sa #47 apically ea RFT #47, ka moemeli oa phapang ka mor'a ho tlosoa ha RFT #47.

Likhaloso: FDOJ, mafura degenerative osteonecrosis ea mohlahare.

E nkiloe ho Lechner le von Baehr, 2015. "Chemokine RANTES/CCL5 e le Sehokelo se sa Tsejoeng pakeng tsa Pholiso ea Leqeba ka har'a Jawbone le Boloetse ba Ts'ebetso: Na Phekolo ea Boprofeta le Tailored e Horizon?" Koranta ea EPMA

Appx III setšoantšo sa 3 Mokhoa oa ho buoa BMDJ/FDOJ ea retromolar. Karolo e ka ho le letšehali: ka mor'a ho phutha lesela la mucoperiosteal, fensetere ea lesapo e ile ea thehoa ka har'a cortex. Phanele e ka ho le letona: sekoti se phekotsoeng sa medulla.

khutsufalitsoeng: BMDJ, bothata ba moko oa masapo mohlahareng; FDOJ, mafura degenerative osteonecrosis ea mohlahare.

E hlophisitsoe ho tsoa ho Lechner, et al, 2021. "Shronic Fatigue Syndrome le Bone Marrow Defects of the Jaw - Tlaleho ea Taba ka Tlhahlobo e Eketsehileng ea X-Ray ea Meno ka Ultrasound." Journal ea Machaba ea Litlaleho tsa Nyeoe ea Bongaka

Appx III setšoantšo sa 4 (a) Pholiso ea FDOJ mohlahareng o ka tlase ka methapo ea infra-alveolar e senyehileng. (b) X-ray e tsamaellanang ntle le matšoao a ts'ebetso ea pathological mohlahareng.

khutsufalitsoeng: FDOJ, mafura degenerative osteonecrosis ea mohlahare

E hlophisitsoe ho tloha Lechner, et al, 2015. "Peripheral Neuropathic Facial / Trigeminal Pain le RANTES / CCL5 ho Jawbone Cavitation." Tlatsetso e Thehiloeng ka Bopaki le Bongaka bo Bong

Appx III Movie 1

Sekotwana sa video (tobetsa habeli setšoantšong ho sheba sekotwana) sa opereishene ea lesapo la mohlahare e bontšang mahlahahlaha a mafura le mahlahahlaha a tsoang mohlahareng oa mokuli ea neng a belaelloa hore o na le necrosis ea mohlahare. Ka tlhompho ea Dr. Miguel Stanley, DDS

Appx III Movie 2

Sekotwana sa video (tobetsa habeli setšoantšong ho sheba sekotwana) sa opereishene ea lesapo la mohlahare e bontšang mahlahahlaha a mafura le mahlahahlaha a tsoang mohlahareng oa mokuli ea neng a belaelloa hore o na le necrosis ea mohlahare. Ka tlhompho ea Dr. Miguel Stanley, DDS

Ho daunelouda kapa ho hatisa leqephe lena ka puo e 'ngoe, khetha puo ea hau ho tsoa lethathamong le kaholimo ho le letšehali pele.

IAOMT Position Paper on Human Jawbone Cavitations Authors