No ka hoʻoiho ʻana a paʻi paha i kēia ʻaoʻao ma kahi ʻōlelo ʻē aʻe, e koho i kāu ʻōlelo mai ka papa kuhikuhi hāʻule i lalo ma ka ʻaoʻao hema mua.

Pepa Kūlana IAOMT ma nā ʻāwae iwi ā kanaka

Ka Luna o ke Komite Pathology Jawbone: Ted Reese, DDS, MAGD, NMD, FIAOMT

Karl Anderson, DDS, MS, NMD, FIAOMT

Patricia Berube, DMD, MS, CFMD, FIAOMT

ʻO Jerry Bouquot, DDS, MSD

Teresa Franklin, PhD

ʻO Jack Kall, DMD, FAGD, MIAOMT

Cody Kriegel, DDS, NMD, FIAOMT

Sushma Lavu, DDS, FIAOMT

ʻO Tiffany Shields, DMD, NMD, FIAOMT

Mark Wisniewski, DDS, FIAOMT

Makemake ke kōmike e hōʻike i ko mākou mahalo iā Michael Gossweiler, DDS, MS, NMD, Miguel Stanley, DDS a me Stuart Nunally, DDS, MS, FIAOMT, NMD no kā lākou hoʻohewa ʻana i kēia pepa. Makemake nō hoʻi mākou e ʻike i nā haʻawina koʻikoʻi a me ka hoʻoikaika ʻana i hana ʻia e Dr. Nunnally i ka hōʻuluʻulu ʻana i ka pepa kūlana 2014. ʻO kāna hana, hoʻoikaika a hoʻomaʻamaʻa i ka iwi kuamoʻo no kēia pepa hou.

Apono ʻia e ka IAOMT Board of Directors September 2023

Ka Papa Hana Ana

Introduction

mō'aukala

ʻike,

Cone beam computed tomography (CBCT)

'Ohanahana

Biomarkers a me ka Histological Examination

Nā Manaʻo Hoʻololi no nā kumu diagnostic

Thermography

Acupuncture Meridian Assessment

NāʻAha Nino

Nā Manaʻo Pūnaehana a me nā Pilikino

Nā ʻano hana lapaʻau

Nā Kūlana Lapaʻau ʻē aʻe

hopena a

E hoʻomaopopo '

Hāpono I IAOMT Survey 2 Nā hualoaʻa

Haawina II IAOMT Survey 1 Nā hualoaʻa

Pākuʻi III Images

Kiʻi 1 Fatty degenerative osteonecrosis o ka iwi āwae (FDOJ)

Hōʻike 2 Cytokines ma FDOJ i hoʻohālikelike ʻia me nā Mana Ola

Kiʻi 3 ʻO ke kaʻina hana no ka FDOJ retromolar

Helu 4 Curettage a me x-ray pili o FDOJ

Nā kiʻiʻoniʻoni wikiō o ka ʻoki ʻana i ka iwi ā i nā maʻi

Introduction

I loko o nā makahiki he ʻumi i hala iho nei, ua ulu ka ʻike ma waena o ka lehulehu a me nā mea mālama ola kino i kahi loulou ma waena o ke olakino waha a me ka ʻōnaehana. No ka laʻana, ʻo ka maʻi periodontal kahi mea pilikia no ka maʻi maʻi a me ka maʻi puʻuwai. Ua hōʻike pū ʻia kekahi loulou e pili ana i ka hopena a me ka hoʻonui ʻia ʻana o ka noiʻi ʻana ma waena o ka patology iwi iwi a me ke olakino holoʻokoʻa a me ka ikaika o ke kanaka. ʻO ka hoʻohana ʻana i nā ʻano hana kiʻi kiʻi ʻenehana e like me ka cone-beam computed tomography (CBCT) i mea kōkua i ka ʻike ʻana i nā pathologies iwi iwi, i alakaʻi i ka hoʻomaikaʻi ʻana i ka hiki ke diagnostic a me ka hiki ke loiloi i ka kūleʻa o nā hana ʻoki. Ua hoʻonui ka ʻike o ka lehulehu i kēia mau pathologies, ʻoi aku ka nui o ka poʻe e loaʻa ana i nā kūlana neurological maʻi ʻole i wehewehe ʻole ʻia i pane ʻole i nā hana lapaʻau a i ʻole nā ​​niho kuʻuna.

Ua hoʻokumu ʻia ka International Academy of Oral Medicine and Toxicology (IAOMT) ma luna o ka manaʻoʻiʻo ʻo ka ʻepekema ke kumu e koho ai a hoʻohana ʻia nā ʻano hana diagnostic a me ka mālama ʻana. ʻO ia me kēia mea nui i ka noʻonoʻo e 1) hāʻawi mākou i kēia mea hou i kā mākou 2014 IAOMT Jawbone Osteonecrosis Position Paper, a 2) noi, e pili ana i ka nānā ʻana i ka histological, kahi inoa ʻepekema a me ka lāʻau lapaʻau no ka maʻi, ʻo ia hoʻi, Chronic Ischemic Medullary Disease. o ka iwi auwae (CIMDJ). Hōʻike ʻo CIMDJ i kahi maʻi iwi i hōʻike ʻia e ka make ʻana o nā ʻāpana kelepona o ka iwi cancellous, ʻelua i ka hoʻopau ʻana i ke koko. I loko o kona mōʻaukala, ʻo ka mea a mākou e ʻōlelo nei ʻo CIMDJ ua kuhikuhi ʻia e ka lehulehu o nā inoa a me nā acronyms i helu ʻia ma ka Papa 1 a e kūkākūkā pōkole ʻia ma lalo nei.

ʻO ka pahuhopu a me ka manaʻo o kēia Academy a me ka pepa, ʻo ia ka hāʻawi ʻana i ka ʻepekema, noiʻi, a me nā ʻike lapaʻau no nā poʻe maʻi a me nā kauka e hana i nā hoʻoholo ʻike i ka wā e noʻonoʻo ai i kēia mau leona CIMDJ, i kapa pinepine ʻia he cavitations iwi āwae. Ua hana ʻia kēia pepa 2023 ma kahi hoʻoikaika hui pū ʻana me nā kauka lapaʻau, nā mea noiʻi a me kahi mea maʻi maʻi iwi āwae kaulana, ʻo Dr. Jerry Bouquot, ma hope o ka loiloi ʻana o nā ʻatikala he 270.

mō'aukala

ʻAʻohe iwi ʻē aʻe ka nui o ka ʻeha a me nā maʻi e like me ka iwi ā. ʻO ka nānā ʻana i nā puke e pili ana i ke kumuhana o ka iwi āwae, (ʻo ia hoʻi, CIMDJ) hōʻike ʻia ua ʻike ʻia kēia maʻi, mālama ʻia a noiʻi ʻia mai ka makahiki 1860. I ka makahiki 1867, ua hāʻawi ʻo Kauka HR Noel i kahi hōʻike i kapa ʻia He haʻiʻōlelo no ka caries a me ka necrosis o ka iwi ma ka Baltimore College of Dental Surgery, a ma ka makahiki 1901 ua kūkākūkā ʻia nā cavitations iwi āwae i ka lōʻihi e William C. Barrett ma kāna puke haʻawina i kapa ʻia ʻo Oral Pathology and Practice: A Textbook for the Use of Students in Dental Colleges and a Handbook for Dental Practitioners. ʻO GV Black, i kapa pinepine ʻia ʻo ka makua kāne o ka lāʻau lapaʻau niho hou, ua hoʻokomo ʻo ia i kahi ʻāpana i kāna puke 1915, Special Dental Pathology, e wehewehe i ke ʻano maʻamau a me ka mālama ʻana i kāna mea i wehewehe ai he jawbone osteonecrosis (JON).

Me he mea lā ua pau ka noiʻi ʻana i ka iwi āwae a hiki i ka makahiki 1970 i ka wā i hoʻomaka ai kekahi poʻe e noiʻi i ke kumuhana, me ka hoʻohana ʻana i nā inoa like ʻole a me nā lepili, a me ka hoʻopuka ʻana i ka ʻike e pili ana i ia mea i loko o nā puke aʻoaʻo oral pathology hou. No ka laʻana, ma 1992 Bouquot et al i nānā i ka ʻeha intraosseous i nā poʻe maʻi me ka ʻeha maka maʻi a koʻikoʻi (N=135) a ua hoʻokumu i ka huaʻōlelo 'Neuralgia-inducing Cavitational Osteonecrosis', a i ʻole NICO. ʻOiaiʻaʻole i'ōleloʻo Bouquot et al i ka etiology o ka maʻi, ua hoʻoholo lākou he mea hiki i nāʻeha ke hoʻoulu i ka neuralgia facial maʻamau me nā hiʻohiʻona kūikawā kūikawā: intraosseous cavity formation a me ka iwi necrosis lōʻihi me ka ho'ōla liʻiliʻi. Ma kahi noiʻi hoʻokolohua o nā maʻi me ka trigeminal (N = 38) a me ka maka (N = 33) neuralgia, Ratner et al, ua hōʻike pū ʻia ʻo ka aneane āpau o nā maʻi i loaʻa nā lua i ka iwi alveolar a me ka iwi iwi. ʻO nā lua, i kekahi manawa ʻoi aʻe ma mua o 1 kenimika ke anawaena, aia ma nā wahi o ka unuhi ʻana o nā niho mua a ʻaʻole hiki ke ʻike ʻia e nā x-ray.

Loaʻa nā ʻano huaʻōlelo ʻē aʻe no ka mea a mākou e ʻike ai he CIMDJ i loko o ka palapala. Ua helu ʻia kēia ma ka Papa 1 a kūkākūkā pōkole ma aneʻi. Ua hoʻokumu ʻo Adams et al i ka huaʻōlelo Chronic Fibrosing Osteomyelitis (CFO) ma kahi pepa kūlana 2014. ʻO ka pepa kūlana he hopena o kahi hui multidisciplinary o nā loea mai nā kahua o ka Oral Medicine, Endodontics, Oral Pathology, Neurology, Rheumatology, Otolaryngology, Periodontology, Psychiatry, Oral and Maxillofacial Radiology, Anesthesia, General Dentistry, Internal Medicine, and Pain Management . ʻO ka manaʻo o ka hui ʻo ia ka hoʻolako ʻana i kahi kahua interdisciplinary e mālama i nā maʻi e pili ana i ke poʻo, ka ʻāʻī, a me ka maka. Ma o ka hui pū ʻana o kēia pūʻulu, nā ʻimi puke nui a me nā nīnauele hoʻomanawanui, ua puka mai kahi ʻano lāʻau lapaʻau ʻokoʻa, a lākou i kapa ai ʻo CFO. Ua ʻike lākou ʻaʻole ʻike pinepine ʻia kēia maʻi ma muli o kāna mau co-morbidities me nā kūlana ʻōnaehana ʻē aʻe. Ua hōʻike kēia hui i nā pilina pili ma waena o ka maʻi a me nā pilikia olakino a me ka pono o kahi hui o nā kauka e hōʻoia pono a mālama i ka mea maʻi.

Ua ʻike ʻia nā ʻeha cavitational iwi iwi i nā keiki. Ma 2013, ua wehewehe ʻo Obel et al i nā ʻeha i nā keiki a ua hoʻokumu i ka huaʻōlelo Juvenile Mandibular Chronic Osteomyelitis (JMCO). Ua manaʻo kēia hui i ka hoʻohana ʻana i nā bisphosphonates intravenous (IV) i mea lapaʻau no kēia mau keiki. Ma 2016 Padwa et al i hoʻopuka i kahi haʻawina e wehewehe ana i kahi osteitis inflammatory sterile i loko o nā iwi āwae o nā keiki. Ua kapa inoa lākou i ka maʻi Pediatric Chronic Nonbacterial Osteomyelitis (CNO).

Mai ka makahiki 2010, ua noiʻi ʻo Kauka Johann Lechner, ka mea kākau a me ka mea noiʻi e pili ana i nā ʻeha cavitational iwi iwi, a me nā mea ʻē aʻe e noiʻi ana i ka pilina o kēia mau ʻeha i ka hana cytokine, ʻoi aku ka nui o ka cytokine inflammatory RANTES (ʻike ʻia ʻo CCL5). Ua hoʻohana ʻo Kauka Lechner i nā huaʻōlelo like ʻole no ka wehewehe ʻana i kēia mau maʻi i hoʻokomo ʻia i ka NICO i ʻōlelo mua ʻia akā ʻo Aseptic Ischemic Osteonecrosis i ka Jawbone (AIOJ), a me Fatty Degenerative Osteonecrosis o ka Jawbone (FDOJ). Hoʻokumu ʻia kāna wehewehe / lepili ma ke ʻano kino a / a i ʻole ke kūlana macroscopically pathological e nānā ʻia ana ma ke kino a i ʻole intraoperatively.

I kēia manawa, pono e wehewehe i kekahi maʻi ʻāwae hou i ʻike ʻia i ʻokoʻa mai ke kumuhana o kēia pepa akā hiki ke huikau i ka poʻe e noiʻi nei i nā ʻeha cavitational. He mau ma'i iwi keia o ka auwae i puka mai ma muli o ka hoohana ana i na laau lapaau. ʻOi aku ka maikaʻi o nā ʻeha ma muli o ka lilo ʻana o ke koko me ka hoʻopaʻa ʻole ʻia o ka iwi. Ua kapa ʻia kēia mau ʻeha e Ruggiero et al ma kahi pepa kūlana no ʻAhahui ʻAmelika o nā Kahuna ʻlelo waha a me Maxillofacial (AAOMS), a me Palla et al, ma kahi loiloi ʻōnaehana. Ma muli o ka pili ʻana o kēia pilikia i ka hoʻohana ʻana i hoʻokahi a i ʻole mau lāʻau lapaʻau, ʻo ka IAOMT ka manaʻo e wehewehe maikaʻi ʻia kēia ʻano lesion e like me ka Osteonecrosis pili i ka lāʻau lapaʻau (MRONJ). ʻAʻole e kūkākūkā ʻia ʻo MRONJ ma kēia pepa no ka mea he ʻokoʻa kona etiology a me nā ala lapaʻau mai ka mea a mākou e ʻōlelo nei ʻo CIMDJ, a ua aʻo nui ʻia ma mua.

ʻO DIAGNOSIS

ʻO ka hoʻohana maʻamau o ka Cone-beam computed tomography (CBCT) radiographs e nā kauka niho he nui i alakaʻi i ka hoʻonui ʻana i ka mālama ʻana i nā cavitations intramedullary a mākou e kapa nei ʻo CIMDJ, a ua nānā ʻole ʻia ma mua a no laila ʻaʻole mālama ʻia. I kēia manawa ua ʻike maʻalahi kēia mau ʻeha a me nā anomalies, ua lilo ia i kuleana o ka ʻoihana niho e ʻike i ka maʻi a hāʻawi i nā ʻōlelo aʻoaʻo a me ka mālama.

ʻO ka mahalo a me ka ʻike ʻana i ke ola ʻana o CIMDJ ka hoʻomaka ʻana o ka hoʻomaopopo ʻana. No ka nui o nā inoa a me nā acronyms i pili i ka pathology, ua hoʻokumu maikaʻi ʻia ka loaʻa ʻana o ka necrotic, a i ʻole ka iwi make i ka medullary component o ka iwi ā.

Ke nānā ʻia i ka wā o ke kaʻa ʻana, ʻike ʻia kēia mau hemahema iwi ma nā ʻano he nui. Ke hōʻike nei kekahi poʻe hoʻomaʻamaʻa ma luna o 75% o nā ʻeha ua piha a piha i ka ʻiʻo palupalu, hina-ʻeleʻele a demineralized/granulomatis, pinepine me nā mea aila melemele (ʻaila ʻaila) i loaʻa i nā wahi hemahema me ka anatomi iwi maʻamau. Hōʻike nā poʻe ʻē aʻe i ka loaʻa ʻana o nā cavitations e ʻokoʻa ana ka nui o ka iwi cortical i ka wā e wehe ai, ʻike ʻia nā linings me nā mea filamentous ʻeleʻele, ʻeleʻele a hina paha. Ke hōʻike nei kekahi poʻe i nā loli nui i wehewehe ʻia he "gritty", "like sawdust", "hollow cavities", a me ka "maloʻo" me ka sclerotic, e like me ka niho o ka paʻakikī o nā paia lua. Ma ka nānā ʻana i ka mōʻaukala, ʻike ʻia kēia mau ʻeha me ka necrosis i loaʻa i nā iwi ʻē aʻe o ke kino a ʻokoʻa ka histologically me ka osteomyelitis (E nānā i ke Kiʻi 1). Hoʻokomo ʻia nā kiʻi hou e hōʻike ana i ka maʻi CIMDJ, kekahi mau kiʻi i ke ʻano, ma ka Appendix III ma ka hope o kēia palapala.

Hōʻike 1 Nā kiʻi o CIMDJ i lawe ʻia mai kahi cadaver

E like me nā kauka olakino ʻē aʻe, hoʻohana nā niho niho i kahi kaʻina hana i hoʻohana i nā ʻano hana like ʻole a me nā ʻano hana e ʻike ai i nā ʻeha cavitational. ʻO ia paha ka hana ʻana i kahi hoʻokolohua kino e pili ana i ka lawe ʻana i ka mōʻaukala olakino, ka loiloi ʻana i nā hōʻailona, ​​​​ka loaʻa ʻana o nā wai o ke kino no ka hoʻāʻo ʻana i ka hale hoʻokolohua, a me ka loaʻa ʻana o nā ʻāpana kiko no ka biopsy a no ka hoʻāʻo microbiological (ʻo ia hoʻi, ka hoʻāʻo ʻana no ka loaʻa ʻana o nā pathogens). Hoʻohana pinepine ʻia nā ʻenehana kiʻi, e like me CBCT. I nā poʻe maʻi me nā maʻi paʻakikī ʻaʻole e hahai mau i kahi ʻano a i ʻole kūpono i kahi ʻano maʻamau o kahi hōʻailona paʻakikī, hiki i ke kaʻina hana diagnostic ke koi aku i kahi kānana kikoʻī a i ka wā mua e hopena i kahi hōʻailona ʻokoʻa. Hōʻike ʻia nā wehewehe pōkole o kēia mau ʻano diagnostic ma lalo nei.

Cone beam computed tomography (CBCT)

ʻO nā ʻenehana diagnostic i wehewehe ʻia i ka makahiki 1979 e Ratner a me nā hoahana, me ka hoʻohana ʻana i ka palpation kikohoʻe a me nā kaomi, diagnostic local anesthetic injections, noʻonoʻo i nā moʻolelo olakino a me kahi o ka ʻeha ʻana he mea pono i ka ʻike ʻana i nā cavitations iwi. Eia naʻe, ʻoiai kekahi o kēia mau ʻeha e hoʻoulu ai i ka ʻeha, ka pehu, ka ʻulaʻula a me ke kuni, ʻaʻole naʻe kekahi. No laila, pono pinepine kahi ana i ʻoi aku ka pahuhopu, e like me ke kiʻi.

ʻAʻole ʻike ʻia nā cavitations ma nā kiʻiʻoniʻoni radiographic ʻelua dimensional maʻamau (2-D e like me, periapical a panoramic) i hoʻohana mau ʻia i ka lāʻau lapaʻau niho. Ua hōʻike ʻo Ratner a me nā hoa hana he 40% a ʻoi aʻe paha o ka iwi e pono e hoʻololi e hōʻike i nā loli, a kākoʻo ʻia kēia e ka hana hope loa, a hōʻike ʻia ma ka Figure 2. Ua pili kēia i ka palena ʻokoʻa o ke kiʻi 2-D e hoʻokumu ai i ka superimposition. o nā hale anatomical, masking wahi hoihoi. I ka hihia o nā hemahema a i ʻole nā ​​maʻi maʻi, ʻo ia hoʻi ma ka mandible, ʻoi aku ka nui o ka hopena masking o ka iwi cortical paʻa i nā hale lalo. No laila, koi ʻia nā ʻenehana kiʻi ʻenehana e like me CBCT, Tech 99 scans, magnetic resonance imaging (MRI), a i ʻole trans-alveolar ultrasound sonography (CaviTAU™®).

ʻO nā ʻano hana kiʻi like ʻole i loaʻa, ʻo ka CBCT ka mea hoʻohana maʻamau i hoʻohana ʻia e nā kauka niho i komo i ka ʻike ʻana a i ʻole ka mālama ʻana i nā cavitations, a no laila ka mea a mākou e kūkākūkā hohonu ai. ʻO ka pōhaku kihi o ka ʻenehana CBCT ʻo ia ka hiki ke nānā i kahi lesion o ka hoihoi i nā ʻāpana 3 (frontal, sagittal, coronal). Ua hōʻoia ʻia ʻo CBCT he ala hilinaʻi a pololei no ka ʻike ʻana a me ka helu ʻana i ka nui a me ka nui o nā hemahema intra-bony i loko o ka iwi ā me ka liʻiliʻi o ka distortion a me ka liʻiliʻi o ka hoʻonui ʻana ma mua o 2-D x-ray.

Hōʻike 2 Caption: Ma ka ʻaoʻao hema e hōʻike ʻia nā radiograph 2-D o nā iwi āwae i lawe ʻia mai nā mea make i ʻike ʻia.

olakino. Aia ma ka ʻaoʻao ʻākau o ke kiʻi nā kiʻi o nā iwi āwae like e hōʻike ana i ka necrotic cavitation.

Hoʻololi ʻia ke kiʻi mai Bouquot, 2014.

Ua hōʻike ʻia nā noiʻi maʻi lapaʻau i nā kiʻi CBCT e kōkua pū i ka hoʻoholo ʻana i nā mea i loko o kahi lesion (piʻi wai, granulomatous, solid, etc.), hiki ke kōkua i ka hoʻokaʻawale ʻana ma waena o nā ʻeha ʻeha, nā ʻōpū odontogenic a i ʻole non-odontogenic, cysts, a me nā mea ʻē aʻe. nā ʻeha .

Hoʻohana ʻia nā polokalamu hou i kūkulu ʻia i hui pū ʻia me nā ʻano mea like ʻole o ka CBCT i nā ʻāpana Hounsfield (HU) e ʻae ai i ka loiloi maʻamau o ka iwi iwi. Hōʻike ʻo HU i ka mānoanoa pili o nā ʻiʻo kino e like me ka pālākiō ʻeleʻele i hoʻopaʻa ʻia, ma muli o nā waiwai no ka ea (-1000 HU), wai (0 HU), a me ka iwi iwi (+1000 HU). Hōʻike ka Kiʻi 3 i nā manaʻo like ʻole o kahi kiʻi CBCT hou.

No ka hōʻuluʻulu ʻana, ua hōʻoia ʻo CBCT i ka pono i ka ʻike a me ka mālama ʻana i nā cavitations iwi ā:

1. ʻIke i ka nui, ka laulā a me ke kūlana 3-D o kahi lesion;
2. ʻO ka ʻike ʻana i kahi kokoke o kahi ʻeha i nā hale anatomical koʻikoʻi e pili ana e like me ka

ke aʻalolo alveolar inferior, maxillary sinus, a i ʻole nā ​​aʻa niho pili;

1. Ka hoʻoholo ʻana i ke ʻano o ka mālama ʻana: ka ʻoki ʻana me ka ʻoki ʻole; a
2. Ka hāʻawiʻana i kahi kiʻi hahai e hoʻoholo i ke kiʻekiʻe o ka ho'ōla a me ka pono kūpono

e hana hou i ka lesion.

Hōʻike 3 Hoʻomaikaʻi ʻia ka mālamalama o ke kiʻi CBCT ma muli o ka ʻenehana polokalamu hoʻomaʻemaʻe, e hōʻemi ana i nā mea kiʻi a me ka "noise" e hiki ai i nā implants niho a me nā hoʻihoʻi metala ke hana i ke kiʻi. ʻAe kēia i ka dentist a me ka mea maʻi e ʻike maʻalahi i ka lesion. ʻO ka papa luna he hiʻohiʻona panoramic o kahi CBCT e hōʻike ana i ka hema (#17) a me ka ʻākau (#32) kahi a me ka nui o nā ʻeha cavitational i kahi maʻi osteonecrosis iwi iwi. ʻO ka ʻaoʻao hema hema kahi ʻike saggital o kēlā me kēia pūnaewele. ʻO ka ʻaoʻao ʻākau ma lalo he hōʻike 3-D o ka pūnaewele #17 e hōʻike ana i ka porosity cortical ma luna o ka cavitation medullary. Na Kauka Reese.

'Ohanahana

Ke haʻi pōkole nei mākou ma ʻaneʻi i kahi mea hana ultrasound, ʻo CaviTAU™®, i kūkulu ʻia a hoʻohana ʻia ma nā ʻāpana o ʻEulopa, no ka ʻike ʻana i nā wahi haʻahaʻa haʻahaʻa o ka iwi ā luna a me lalo e hōʻike ana i nā cavitations iwi. Ua like paha kēia mea hana kani ultrasonic trans-alveolar (TAU-n) i ka hoʻohālikelike ʻana me CBCT i ka ʻike ʻana i nā hemahema o ka iwi ā iwi, a loaʻa iā ia ka pōmaikaʻi hou o ka wehe ʻana i ka mea maʻi i nā pae haʻahaʻa haʻahaʻa o ka radiation. ʻAʻole loaʻa kēia hāmeʻa ma US akā ke nānā ʻia nei e ka US Food and Drug Administration a hiki ke lilo i mea hana diagnostic mua i hoʻohana ʻia ma ʻAmelika ʻĀkau e mālama iā CIMJD.

Biomarkers a me ka Histological Examination

Ma muli o ke ʻano inflammatory o nā cavitations iwi ā Lechner a me Baehr, ua noiʻi ʻo 2017 i ka pilina ma waena o nā cytokines koho a me ka maʻi. Hoʻokahi cytokine o ka hoihoi 'i hoʻoponopono ʻia ma ka hoʻāla ʻana, hōʻike a hūnā ʻia ʻo T-cell maʻamau' (RANTES). ʻO kēia cytokine, a me ka fibroblast growth factor (FGF) -2, ua hōʻike ʻia i ka nui o nā leona cavitational a me nā maʻi me CIMDJ. Hōʻike 4, hāʻawi ʻia e Kauka Lechner, hoʻohālikelike i nā pae o RANTES i nā maʻi me nā cavitations (ka ʻulaʻula, hema) me nā pae i nā mana olakino (blue bar), e hōʻike ana i nā pae i ʻoi aku ma mua o 25 mau manawa i ka poʻe me ka maʻi. Hoʻohana ʻo Lechner et al i ʻelua ala e ana i nā pae cytokine. ʻO kekahi ke ana i nā pae o nā cytokines systemically mai ke koko (Laboratory Solutions Diagnostic, US.). ʻO ke ala ʻelua, ʻo ia ke lawe pololei ʻana i kahi biopsy mai ka wahi maʻi i ka wā i loaʻa ai e loiloi ʻia e ke kanaka pathologist waha. ʻO ka mea pōʻino, i kēia manawa, pono ka hoʻoheheʻe ʻia ʻana o ka ʻiʻo kūloko i ka hana paʻakikī a me ka hoʻouna ʻana i hiki ʻole ke hoʻokō ʻia ma nā keʻena noiʻi ʻole, akā ua hāʻawi ia i nā pilina ʻike.

Hōʻike 4 Ka puunaue ana o RANTES ma 31 mau hihia FDOJ a me 19 mau laana o ka iwi auwae ma'amau i ka hoohalike ana me ka x-ray density reference no na hui elua ma na wahi pili. Nā pōā: ʻO RANTES, hoʻoponopono ʻia ma ka hoʻāla ʻana, hōʻike ʻia a huna ʻia ka chemokine (CC motif) ligand 5; XrDn, mānoanoa X-ray; FDOJ, momona degenerative osteonecrosis o ka iwi āwae; n, helu; Ctrl, hoʻomalu. Hōʻike ʻia e Kauka Lechner. Helu laikini: CC BY-NC 3.0

Nā Manaʻo Hoʻololi no nā kumu diagnostic

Ua hoʻokumu maikaʻi ʻia ka hele ʻana o nā cavitations iwi āwae i ka lāʻau lapaʻau. Eia nō naʻe, pono e noiʻi hou i nā diagnoses a me nā ʻāpana lapaʻau maikaʻi loa. Me ia noʻonoʻo pono e haʻi pōkole i kekahi mau ʻenehana hoihoi a waiwai nui e hoʻohana ʻia nei e kekahi mau loea.

Thermography

Ua ʻike ʻia ʻo nā loiloi physiologic hou he mea pono no ka nānā ʻana a me ka diagnostic. ʻO kekahi o ia mau mea hana e hoʻohana ʻia e kekahi mau loea ʻo ia ke kiʻi thermographic. Hiki ke ʻike ʻia ka hana inflammatory ma ke ana ʻana i nā ʻokoʻa wela ma ka ʻili o ke poʻo a me ka ʻāʻī. He palekana, wikiwiki a loaʻa paha ka waiwai diagnostic like me ka CBCT. ʻO kahi drawback koʻikoʻi ʻo ia ka nele i ka wehewehe ʻana, e paʻakikī ke ʻike i ka palena a i ʻole ka nui o kahi lesion.

Acupuncture Meridian Assessment

Ke nānā nei kekahi mau loea i ka ʻike ikaika o kahi lesion e hoʻohana ana i ka Acupuncture Meridian Assesment (AMA) e hoʻoholo ai i kona hopena i kāna meridian ikehu. Hoʻokumu ʻia kēia ʻano loiloi ma Electroacupuncture Wahi a Voll (EAV). ʻO kēia ʻenehana, kahi i hoʻokumu ʻia i ka lāʻau lapaʻau Kina kahiko a me nā loina acupuncture, ua hoʻomohala ʻia a ke aʻo ʻia nei ma US. Ua hoʻohana ʻia ka Acupuncture e hōʻemi i ka ʻeha a hoʻoikaika i ka ho'ōla. Hoʻokumu ʻia ia ma ke koena o ke kahe o ka ikehu (ie, Chi) ma o nā ala kikoʻī o ka ikehu i loko o ke kino. ʻO kēia mau ala, a i ʻole meridian, e hoʻopili i nā ʻano kikoʻī, nā ʻiʻo, nā ʻiʻo a me nā iwi me kekahi. Hoʻohana ʻo Acupuncture i nā kiko kikoʻī loa ma kahi meridian e hoʻoikaika i ke olakino a me ka ikaika o nā mea kino āpau ma kēlā meridian. Ua hoʻohana ʻia kēia ʻenehana no ka hōʻike ʻana i ka maʻi iwi ā, i ka wā e hoʻoholo ʻia ai, mālama pū kekahi i nā maʻi like ʻole e pili ana, e like me ka arthritis a i ʻole ka maʻi luhi mau loa. Hiki i kēia ʻenehana ke noiʻi hou aku (ʻo ia hoʻi, pono e kākau ʻia nā hopena a loaʻa a hoʻolaha ʻia ka ʻikepili lōʻihi).

NĀ HOʻOPIʻI RISK

Nui nā kumu hoʻokahi e hoʻonui ai i ka pilikia no ka ulu ʻana o nā cavitations iwi ā, akā ʻo ka maʻamau he multifactorial ka pilikia. Hiki i nā pilikia i ke kanaka ke hoʻololi i waho, e like me nā kumu kaiapuni a i ʻole nā ​​hopena o loko, e like me ka maikaʻi ʻole o ka hana immune. Papa helu 2 a me 3 nā kumu pilikia o waho a me loko.

E hoʻomaopopo i ka Papa 2, Nā Kūlana Kūloko, ʻaʻole i hoʻokomo i ka predisposition genetic. ʻOiai e noʻonoʻo ʻia nā ʻano ʻokoʻa genetic ke kuleana, ʻAʻole i hōʻike ʻia ka hoʻololi ʻana o nā genes hoʻokahi a i ʻole ka hui pū ʻana o nā genes i ʻike ʻia he kumu pilikia, akā naʻe, ʻike ʻia nā hopena genetic. . Ua hōʻike ʻia kahi loiloi palapala ʻōnaehana i 2019 ua ʻike ʻia he nui o nā polymorphism nucleotide hoʻokahi, akā ʻaʻohe replication ma nā haʻawina. Ua hoʻoholo nā mea kākau i ka hāʻawi ʻana i ka ʻokoʻa o nā genes i hōʻike i nā hui maikaʻi me nā cavitations a me ka nele o ka reproducibility o nā haʻawina, e ʻike ʻia ka hana i hoʻokani ʻia e nā kumu genetic i ke ʻano a me ka heterogeneous. Eia nō naʻe, pono paha ka huli ʻana i nā heluna kanaka e ʻike i nā ʻokoʻa genetic. ʻOiaʻiʻo, e like me ka mea i hōʻike ʻia, ʻo kekahi o nā ʻano pathophysiologic maʻamau a maʻamau o ka pōʻino o ka iwi ischemic, ʻo ia ka nui o ka clotting mai nā mokuʻāina hypercoagulation, ka mea maʻamau i nā genetic underpinnings, e like me ka wehewehe ʻana e Bouquot and Lamarche (1999). ʻO ka papa 4 i hāʻawiʻia e Dr. Bouquot, e papa inoa i nā'ōlelo maʻi e pili ana i ka hypercoagulation aʻo nā paukū 3 e hiki mai ana e hāʻawi i ka nānāʻana i kekahi o nā mea iʻikeʻia e Dr. Bouquot i hōʻikeʻia ma kāna kūlana ma keʻano he Luna Hoʻonaʻauao ma ka Maxillofacial Center for Education and Research.

I loko o ka iwi āwae he hōʻike maopopo o ka ischemic osteonecrosis, ʻo ia ka maʻi iwi iwi kahi e necrotic ai ka iwi ma muli o ka nele o ka oxygen a me nā meaʻai. E like me ka mea i ʻōlelo ʻia, hiki i nā mea he nui ke hoʻopili i ka hana ʻana i nā cavitations a hiki i ka 80% o nā mea maʻi i loaʻa ka pilikia, maʻamau i hoʻoili ʻia, o ka hana nui ʻana o nā koko koko i loko o ko lākou mau kīʻaha koko. ʻAʻole ʻike ʻia kēia maʻi maʻamau i ka wā o nā hoʻāʻo koko maʻamau. Hiki ke ma'alahi ka iwi i kēia pilikia o ka hypercoagulation a ho'omohala nui i nā kī'aha koko; hoʻonui, pinepine i kaʻeha, nā pilikia o loko; ʻo ka stagnation o ke koko; a me na infarctions. Hiki ke manaʻo ʻia kēia pilikia hypercoagulation e ka moʻolelo ʻohana o ka hahau ʻana a me ka puʻuwai puʻuwai i ka wā ʻōpiopio (ma lalo o 55 mau makahiki), hoʻololi i ka ʻūhā a i ʻole "arthritis" (ʻoi loa i ka wā ʻōpio), osteonecrosis (ʻoi loa i ka wā ʻōpiopio), hohonu. vein thrombosis, pulmonary emboli (koko koko i loko o ka māmā), retinal vein thrombosis (paʻa i ka retina o ka maka) a me ka hāʻule mau. He 2 pilikia ko'iko'i o na auwae me keia ma'i: 1) i ka wa e poino ai, hiki ole i ka iwi ma'i ke pale aku i na ma'i haahaa mai ka niho a me ka ma'i bacteria; a 2) ʻaʻole hiki ke ola ka iwi mai ke kahe ʻana o ke koko i hoʻoulu ʻia e nā lāʻau lapaʻau kūloko i hoʻohana ʻia e nā kauka niho i ka wā o ka hana niho. Hāʻawi ka Figure 5 i kahi ʻike microscopic o kahi thrombus intravascular.

4 Pūnaewele ʻO nā maʻi e pili ana i ka hypercoagulation. ʻEhā mai loko o ʻelima mau maʻi maʻi cavitation iwi āwae kekahi o kēia mau clotting

pilikia kumu.

Me ka nānā ʻole i ke kumu kumu o ka hypercoagulation, hoʻomohala ka iwi i kahi momona momona (hiki i nā fibers ke noho i nā wahi pōloli meaʻai), kahi momona momona a make ("wet rot"), kahi maloʻo maloʻo, i kekahi manawa ʻili ʻili ("palapala maloʻo" ), a i ʻole he wahi hakahaka piha loa ("cavitation").

Hiki ke pili i kēlā me kēia iwi, akā pili pinepine nā pūhaka, nā kuli a me nā ʻāwae. Paʻa pinepine ka ʻeha akā ma kahi o 1/3^rd ʻaʻole ʻike ka poʻe maʻi i ka ʻeha. Pilikia ke kino e ho'ōla iā ia iho mai kēia maʻi a me 2/3^rds ʻO ka nui o nā hihia e koi ʻia i ka wehe ʻana i ka momona o ka momona, ma ke ʻano maʻamau ma ke ʻoki ʻana me nā curettes. E hoʻopau ka ʻokiʻoki i ka pilikia (a me ka ʻeha) ma kahi o 3/4^{nā mea ʻē} ʻO nā maʻi me ke komo ʻana o ka iwi ā, ʻoiai ʻo ka hana hou ʻana, ʻoi aku ka liʻiliʻi o nā kaʻina hana ma mua o ka mua, pono i 40% o nā mea maʻi, i kekahi manawa ma nā wahi ʻē aʻe o ka ʻāʻī, no ka mea, loaʻa pinepine ka maʻi i nā ʻeha "skip" iwi like a like paha), me ka momona maʻamau ma waena. ʻOi aku ma mua o ka hapalua o nā maʻi ʻūhā e loaʻa i ka maʻi ma ka ʻaoʻao ʻē aʻe. ʻOi aku ma mua o 1/3^rd o ka poe ma'i iwi iwi e loaa ka ma'i ma na wahi e ae o ka iwi a. I kēia mau lā, ua ʻike ʻia he 40% o nā mea maʻi me ka osteonecrosis o ka ʻūhā a i ʻole ka iwi āpau e pane i ka anticoagulation me ka haʻahaʻa haʻahaʻa heparin (Lovenox) a i ʻole Coumadin me ka hoʻonā ʻana o ka ʻeha a me ka ho'ōla iwi.

Hōʻike 5 ʻO ka ʻike microscopic o ka thrombi intravascular

Inā ʻimi ʻoe i kahi ala non-pharmaceutical no ka hōʻemi ʻana i ka pilikia o ka hypercoagulation hiki i kekahi ke noʻonoʻo i ka hoʻohana ʻana i nā enzymes supplemental e like me ka nattokinase a i ʻole ka lumbrokinase ikaika loa i loaʻa iā lākou nā waiwai fibrinolytic a me anticoagulation. Eia kekahi, pono e kāpae ʻia nā ʻōlelo hemahema keleawe, e pili ana i ka coagulation dysfunction, ma muli o ka piʻi nui ʻana o ka hypercoagulation i ʻike ʻia i nā maʻi me nā cavitations iwi.

KA PALAPALA A ME KA PALAPALA

ʻO ka loaʻa ʻana o nā cavitations iwi ā a me kā lākou maʻi maʻi e pili ana i kekahi mau hōʻailona kikoʻī akā hoʻokomo pinepine ʻia kekahi mau hōʻailona ʻōnaehana kikoʻī ʻole. No laila, pono e hoʻokokoke ʻia kāna hōʻailona a me ka mālama ʻana me ka noʻonoʻo pono ʻana e ka hui mālama. ʻO nā ʻike kūʻokoʻa loa a me ka honua i ʻike ʻia mai ka pepa kūlana IAOMT 2014 ʻo ia ka hoʻonā ʻana o nā maʻi ʻeha maʻi maʻi ma hope o ka mālama ʻana i ka cavitation. Inā he ʻano autoimmune nā maʻi ʻōnaehana a i ʻole ka mumū e kū mai ana, ua hōʻike ʻia nā hoʻomaikaʻi nui, me ka hoʻomaikaʻi ʻana i ka maʻi kanesa. ʻO ka hōʻailona paʻakikī e pili ana i kēia mau maʻi he mea hoʻokahi a no laila ʻaʻole hiki ke maʻalahi a maʻalahi paha ke ʻike. No laila, noʻonoʻo ka IAOMT i ka wā e ʻike ʻia ai ka mea maʻi me nā cavitations iwi ā me ka ʻole o ka ʻeha kūloko, a loaʻa pū kekahi maʻi ʻē aʻe i pili ʻole ʻia i nā cavitations iwiāwae, pono ka mea maʻi i ka loiloi hou e hoʻoholo ai inā pili ka maʻi. , a he hopena ia o ka mai. Ua noiʻi ka IAOMT i kona mau lālā e aʻo hou e pili ana i nā hōʻailona / maʻi ʻōnaehana e hoʻoholo ai ma hope o ke ʻoki cavitational. Hōʻike ʻia nā hopena ma ka Appendix I.

ʻO ka loaʻa ʻana o nā cytokines i hana ʻia i loko o ka vascularized maikaʻi ʻole, nā ʻeha necrotic o nā cavitations iwiāwae me he mea lā e hana ʻia ma ke ʻano he kiko o nā cytokine inflammatory e mālama ana i nā wahi ʻē aʻe o ka mumū a / a i ʻole ka maʻi. ʻO ka hōʻoluʻolu a i ʻole ka liʻiliʻi o ka hoʻomaikaʻi ʻana mai ka ʻeha o ka iwi āpau ma hope o ka mālama ʻana ua manaʻolana ʻia a manaʻo ʻia, akā ʻo kēia kumu kumu o ka mumū, e kūkākūkā ʻia ma lalo nei, hiki ke wehewehe i ke kumu o ka nui o nā maʻi like ʻole 'pili ʻole' e pili ana i nā kūlana inflammatory mau. Ua hoʻemi ʻia hoʻi me ka mālama ʻana i ka cavitation.

I ke kākoʻo ʻana i nā manaʻo hoʻoholo i unuhi ʻia ma ka pepa kūlana o ka IAOMT 2014 e hoʻopili ana i nā cavitation iwi ā me nā maʻi ʻōnaehana, noiʻi a me nā noiʻi lapaʻau i paʻi hou ʻia e Lechner, von Baehr a me nā mea ʻē aʻe, e hōʻike ana i nā ʻeha cavitation iwi i kahi ʻano cytokine kikoʻī ʻaʻole i ʻike ʻia i nā pathologies iwi ʻē aʻe. . Ke hoʻohālikelike ʻia me nā laʻana o ka iwi āwae olakino, hōʻike mau nā maʻi cavitation i kahi hoʻoponopono ikaika o ka fibroblast growth factor (FGF-2), Interleukin 1 receptor antagonist (Il-1ra), a me ka mea nui, RANTES. ʻO RANTES, i kapa ʻia ʻo CCL5 (cc motif Ligand 5) ua wehewehe ʻia he cytokine chemotactic me kahi hana proinflammatory ikaika. Ua hōʻike ʻia kēia mau chemokines e keʻakeʻa i kekahi mau pae o ka pane ʻana o ka immune a ua komo nui i nā kūlana pathological a me nā maʻi. Ua hōʻike ʻia nā haʻawina e pili ana ʻo RANTES i nā maʻi ʻōnaehana he nui e like me ka arthritis, chronic fatigue syndrome, atopic dermatitis, nephritis, colitis, alopecia, thyroid disorders a me ka hoʻolaha ʻana o ka maʻi sclerosis a me ka maʻi Parkinson. Eia hou, ua hōʻike ʻia ʻo RANTES e hoʻomaka i ka ulu ʻana o ka maʻi maʻi.

Ua hoʻopili pū ʻia nā mea ulu fibroblast i nā cavitations iwi ā. ʻO nā mea ulu Fibroblast, FGF-2, a me kā lākou mau mea hoʻokipa e pili ana, ke kuleana no nā hana koʻikoʻi, me ka hoʻonui ʻana o ka cell, ke ola, a me ka neʻe ʻana. Hiki iā lākou ke hoʻopaʻa ʻia e nā maʻi maʻi maʻi a me ka pāʻani ʻana i kahi hana oncogenic i nā maʻi maʻi he nui. No ka laʻana, hoʻolaha ʻo FGF-2 i ka piʻi ʻana o ka maʻi ʻaʻai a me ka maʻi kanesa i ka maʻi maʻi prostate. Eia kekahi, ua hōʻike nā pae FGF-2 i ka pilina pololei i ka holomua, ka metastasis a me ka prognosis ola maikaʻi ʻole i nā maʻi maʻi maʻi colorectal. Ke hoʻohālikelike ʻia me nā kaohi ʻole o ka maʻi kanesa, ʻoi aku ka kiʻekiʻe o ka FGF-2 i ka poʻe maʻi me ka maʻi maʻi ʻōpū. Ua hoʻopili ʻia kēia mau ʻelele ʻeha i nā maʻi koʻikoʻi he nui inā he ʻano ʻeha a i ʻole ke kanesa. ʻO ka hoʻohālikelike ʻana me RANTES/CCL5 a me FGF-2, ua hōʻike ʻia ʻo IL1-ra e hana ma ke ʻano he mea hoʻoponopono anti-inflammatory ikaika, e hāʻawi ana i ka nele o nā hōʻailona inflammatory maʻamau i loko o kekahi mau leona cavitation.

Ua hoʻohālikelike ʻia nā pae kiʻekiʻe o RANTES a me FGF-2 i nā ʻeha cavitation i nā pae i ʻike ʻia i nā maʻi ʻē aʻe e like me amyotrophic lateral sclerosis, (ALS) multiple sclerosis (MS), rheumatoid arthritis a me ka maʻi maʻi umauma. ʻOiaʻiʻo, ʻoi aku ka kiʻekiʻe o nā pae o kēia mau ʻelele i ʻike ʻia i nā cavitations iwiāwae ma mua o ka serum a me ka wai cerebrospinal o nā maʻi ALS a me MS. Ua hōʻike ʻia ka noiʻi o kēia manawa e Lechner a me von Baehr i ka piʻi ʻana o RANTES he 26 i loko o nā ʻeha osteonecrotic iwi iwi o nā maʻi maʻi maʻi umauma. Manaʻo ʻo Lechner a me nā hoa hana i ka RANTES i loaʻa i ka cavitation e lilo i mea wikiwiki o ka ulu ʻana a me ka holomua o ka maʻi maʻi umauma.

E like me ka mea i ʻōlelo ʻia ma mua, nui nā hihia o nā cavitations iwi āsymptomatic. I kēia mau hihia, ʻaʻole ʻike ʻia nā cytokine pro-inflammatory acute e like me TNF-alpha a me IL-6, i nā helu i hoʻonui ʻia i nā ʻike pathohistological o nā laʻana cavitation. I kēia mau maʻi, pili ka nele o kēia mau cytokine pro-inflammatory me nā kiʻekiʻe kiʻekiʻe o kahi cytokine anti-inflammatory Interleukin 1-receptor antagonist (Il-1ra). ʻO ka hopena kūpono ʻo ia ka ʻāʻī nui e pili ana i nā cavitations iwi āwae ma lalo o ka mana o nā pae kiʻekiʻe o RANTES/FGF-2. ʻO ka hopena, no ka hana ʻana i kahi hōʻailona, ​​​​ʻōlelo ʻo Lechner lāua ʻo von Baehr e hoʻohaʻahaʻa i ka nānā ʻana i ke alo o ka mumū a noʻonoʻo i ke ala hōʻailona, ​​​​ma mua o ka hōʻike ʻana o RANTES/FGF-2. ʻO nā kiʻekiʻe kiʻekiʻe o RANTES/FGF-2 i nā maʻi cavitation e hōʻike ana i kēia mau ʻeha ke kumu like a hoʻoikaika pū kekahi i nā ala hōʻailona pathogenic i nā kino ʻē aʻe. Hoʻoikaika ʻia ka ʻōnaehana pale i ka pane ʻana i nā hōʻailona pōʻino, kahi e hoʻāla ai i nā ala molekula innate e hoʻopau ai i ka hana cytokine inflammatory a hiki ke hoʻāla ʻia o ka ʻōnaehana immune adaptive. Kākoʻo kēia i ka manaʻo a me ke kumumanaʻo, ʻo ka hoʻoheheʻe ʻana o ka iwi āwae ke kumu kumu o nā maʻi ʻeha mau ma o ka hana ʻana o RANTES/FGF-2 a wehewehe hou aku i ke kumu ʻaʻole ʻike mau ʻia nā hōʻailona o ka mumū a ʻike ʻole ʻia e ka mea maʻi i nā ʻeha iwi iwi. lakou iho. No laila, ʻo nā cavitations iwi ā a me kēia mau ʻelele i hoʻopili ʻia e hōʻike ana i kahi ʻano hoʻohui o ka maʻi inflammatory a lilo i kumu kumu o ka maʻi. ʻO ka wehe ʻana i nā cavitations ke kī i ka hoʻohuli ʻana i nā maʻi ʻeha. Kākoʻo ʻia kēia e ka ʻike ʻana i ka emi ʻana o nā pae serum RANTES ma hope o ka hana ʻana i nā maʻi maʻi maʻi umauma 5 (E nānā i ka Papa 5). ʻO ka noiʻi hou a me ka hoʻāʻo ʻana i nā pae RANTES/CCL5 hiki ke hāʻawi i ka ʻike i kēia pilina. ʻO nā manaʻo hoʻoikaika i ka hoʻomaikaʻi ʻana i ka maikaʻi o ke ola i ʻike ʻia e nā maʻi cavitation iwi āpau, inā he hōʻoluʻolu ma ke kahua o ka hana a i ʻole ka emi ʻana o ka ʻeha mau a i ʻole ka maʻi ma nā wahi ʻē aʻe.

5 Pūnaewele

Hoemi (Red.) ma RANTES/CCL5 i ka serum ma 5 maʻi maʻi maʻi umauma i hana ʻokiʻoki no fatty-degenerative osteonecrosis o ka iwi ā (FDOJ). Pākaukau i hoʻololi ʻia mai

Lechner et al, 2021. Hōʻike ʻia ka Cavitation Iwi Iwi RANTES/CCL5: Ka Hoʻopaʻa ʻana i nā hihia e hoʻopili ana i ka maʻi ʻeha ma ka iwi ā me ka Epistemology of Breast Cancer. ʻO ka maʻi maʻi umauma: nā pahuhopu a me ka lāʻau lapaʻau.

Nā ʻano hana lapaʻau

Ma muli o ka liʻiliʻi o nā palapala e pili ana i ka mālama ʻana i nā maʻi cavitational, ua nānā ka IAOMT i kona lālā e hōʻiliʻili i ka ʻike e pili ana i nā ʻano a me nā lāʻau e ulu nei i kahi 'mālama maʻamau. Kūkākūkā pōkole ʻia nā hopena o ka noiʻi ma ka Appendix II.

Ke hoʻoholo ʻia ka wahi a me ka nui o nā ʻeha, pono nā ʻano hana lapaʻau. ʻO ka IAOMT ka noʻonoʻo ʻaʻole hiki ke ʻae ʻia ka waiho ʻana i ka "iwi make" i loko o ke kino kanaka. Hoʻokumu ʻia kēia ma ka ʻikepili e hōʻike ana e hiki i nā cavitations iwiāwae ke lilo i kumu no nā cytokines systemic a me endotoxins e hoʻomaka i ke kaʻina hana no ka hoʻohaʻahaʻa ʻana i ke olakino holoʻokoʻa o ka mea maʻi.

Ma lalo o nā kūlana kūpono, pono e hana ʻia kahi biopsy no ka hōʻoia ʻana i nā diagnoses o kekahi pathology iwi iwi a kāpae i nā kūlana maʻi ʻē aʻe. A laila, pono ka lapa'au no ka wehe a ho'opau 'ana i ka ma'i ma'i a ho'oulu hou i ka iwi ma'amau. I kēia manawa i loko o nā puke i loiloi ʻia e nā hoa, ʻo ka hoʻomaʻamaʻa ʻana i ka ʻoki ʻana i ka iwi ola ʻole i hoʻopilikia ʻia ʻo ia ka lāʻau maikaʻi loa no nā cavitations iwi ā. Hoʻohana ʻia ka lāʻau lapaʻau i ka hoʻohana ʻana i nā anesthetics kūloko, kahi e alakaʻi ai i kahi noʻonoʻo nui. Ua manaʻo mua ʻia ʻo ka epinephrine i loaʻa i nā anesthetics, ka mea i ʻike i nā waiwai vasoconstrictive, pono e pale ʻia i nā maʻi i hiki ke hoʻololi i ke kahe koko e pili ana i ko lākou kūlana maʻi. Eia nō naʻe, i loko o kahi ʻano o nā haʻawina molecular, ua hoʻonui ʻia ka ʻokoʻa osteoblastic me ka hoʻohana ʻana i ka epinephrine. No laila, pono e hoʻoholo ke kauka lapaʻau i kēlā me kēia hihia inā e hoʻohana i ka epinephrine a inā pēlā, ʻo ka nui e hoʻohana ʻia e hāʻawi i nā hopena maikaʻi loa.

Ma hope o ka hoʻomaʻamaʻa ʻana a me ka curettage piha o ka ʻeha a me ka hoʻoinu ʻana me ka paʻakai maʻamau sterile, hoʻomaikaʻi ʻia ka hoʻōla ʻana ma o ka hoʻokomo ʻana o ka platelet-rich fibrin (PRF) grafts i loko o ka osseous void. ʻAʻole maikaʻi ka hoʻohana ʻana i ka platelet-rich fibrin concentrates i nā kaʻina hana ma ke ʻano o ka clotting, akā mai ke ʻano hoʻi o ka hoʻokuʻu ʻana i nā mea ulu i kahi manawa a hiki i ʻumikumamāhā mau lā ma hope o ke kaʻina. Ma mua o ka hoʻohana ʻana i nā grafts PRF a me nā lāʻau lapaʻau hoʻohui ʻē aʻe, hoʻihoʻi hou ʻia ka lesion osteonecrotic jawbone ma hope o ke ʻoki ʻana ma kahi o 40% o nā hihia.

ʻO ka nānā ʻana i nā kumu pilikia o waho i hōʻike ʻia ma ka Papa 2 e hōʻike ikaika ʻia e hiki ke pale ʻia nā hopena maikaʻi ʻole me ke ʻano hana ʻoki kūpono a me ka launa pū ʻana o ke kauka/maʻi, ʻoi aku hoʻi i nā heluna maʻi. Pono e noʻonoʻo e hoʻohana i nā ʻenehana atraumatic, e hōʻemi a pale i nā maʻi periodontal a me nā maʻi niho ʻē aʻe, a me ke koho ʻana i kahi armamentarium e hiki ai i nā hopena hoʻōla maikaʻi loa. ʻO ka hāʻawi ʻana i nā ʻōlelo aʻo mua a ma hope o ka hana ʻana i ka mea maʻi, me ka pili ʻana i ka pili ʻana me ka puhi paka e hiki ke kōkua i ka hōʻemi ʻana i nā hopena maikaʻi ʻole.

Me ka hoʻomanaʻo ʻana i ka papa inoa ākea o nā kumu pilikia i helu ʻia ma ka Papa 2 a me 3, ʻōlelo ʻia nā kūkākūkā me ka hui mālama lōʻihi o ka mea maʻi e ʻike pono i nā kumu pilikia huna e hiki ke kōkua i ka hoʻomohala ʻana i nā cavitations iwi āwae. No ka laʻana, he mea koʻikoʻi ka noʻonoʻo ʻana i ka mālama ʻana i nā cavitations iwi āwae inā paha e lawe ana ke kanaka i nā antidepressants, ʻo ia hoʻi nā mea hoʻopaneʻe reuptake serotonin koho (SSRIs). Ua hoʻopili ʻia nā SSRI me ka emi ʻana o ka nui o ka iwi a me ka piʻi ʻana o ka haʻi. ʻO ka SSRI Fluoxetine (Prozac) ke kāohi pololei i ka ʻokoʻa osteoblast a me ka mineralization. Ma kahi o ʻelua mau haʻawina kūʻokoʻa e nānā ana i nā mea hoʻohana SSRI i hoʻohālikelike ʻia me nā mana i hōʻike ʻia e pili ana ka hoʻohana ʻana o SRRI me nā ʻike morphometric panoramic ʻoi aku ka maikaʻi.

Hiki i ka preconditioning ke kōkua i nā hopena lapaʻau maikaʻi. Hoʻopili kēia i ka hoʻokumu ʻana i kahi kaiapuni kino e hoʻōla ai ma ka hāʻawi ʻana i ke kino i nā pae kūpono o nā meaʻai kūpono e hoʻomaikaʻi ai i ka ʻāina olaola ma o ka hoʻonui ʻana i ka homeostasis i ke kino. ʻAʻole hiki ke hoʻomaʻamaʻa mua ʻia, a ʻae ʻia paha i ka mea maʻi, akā ʻoi aku ka mea nui no ka poʻe maʻi i ʻike i nā maʻi maʻi, e like me ka poʻe me ka genetic predisposition, nā maʻi hoʻōla a i ʻole ke ola kino. Ma ia mau hihia, he mea koʻikoʻi ka hoʻokō ʻana o kēia optimization e hōʻemi i nā pae o ke koʻikoʻi oxidative, ʻaʻole hiki ke hoʻoulu wale i ke kaʻina maʻi akā hiki ke hoʻopilikia i ka ho'ōla i makemake ʻia.

ʻO ka mea kūpono, pono e hoʻopau ʻia ka hoʻemi ʻana o kekahi ukana ʻona ma ke kino e like me ka fluoride a/a i ʻole ka mercury mai nā hoʻopiha amalgam niho ma mua o ka mālama ʻana i nā cavitations iwiāwae. Hiki i ka Mercury ke hoʻololi i ka hao i loko o ke kaulahao lawe electron o ka mitochondria. Loaʻa kēia i ka hao manuahi (ferrous iron a i ʻole Fe ++), e hana ana i nā ʻano oxygen reactive hōʻino (ROS) i ʻike ʻia hoʻi he radical manuahi, e hoʻoulu ai i ke kaumaha oxidative. ʻO ka nui o ka hao i loko o ka iwi iwi ke keʻakeʻa nei i ka hana kūpono o nā osteoblasts, a he hopena maikaʻi ʻole ke hoʻāʻo e hoʻōla i kahi maʻi iwi.

Pono e hoʻoponopono ʻia nā hemahema ʻē aʻe ma mua o ka mālama ʻana. Ke loaʻa kahi hemahema o ke keleawe bioavailable, magnesium a me retinol, ka metabolism a me ka hana hou ʻana o ka hao e lilo i dysregulated i loko o ke kino, kahi e hoʻonui ai i ka hao manuahi i nā wahi hewa e alakaʻi ai i ke koʻikoʻi oxidative a me ka pilikia o ka maʻi. ʻOi aku ke kikoʻī, nui nā enzymes i loko o ke kino (e like me ka ceruloplasmin) e lilo i mea ʻole i ka wā ʻaʻole lawa nā pae o ke keleawe bioavailable, magnesium, a me retinol, a laila hoʻomau i ka systemic iron dysregulation a me ka hopena o ka piʻi ʻana o ke kaumaha oxidative a me ka pilikia o ka maʻi.

Nā Kūlana Lapaʻau ʻē aʻe

Pono e loiloi ʻia nā ʻano hana ʻē aʻe i hoʻohana ʻia ma ke ʻano he lapaʻau mua a kākoʻo paha. ʻO kēia mau mea e pili ana i ka homeopathy, ka hoʻoulu uila, ka lāʻau māmā e like me ka photobiomodulation, a me ka laser, oxygen grade medical / ozone, hyperbaric oxygen, anticoagulation modalities, Sanum remedies, nutrition and nutraceuticals, infra-red sauna, intravenous ozone therapy, energy treatments, a me nā mea ʻē aʻe. I kēia manawa, ʻaʻole i alakaʻi ʻia ka ʻepekema e hōʻoia i kēia mau ʻano lapaʻau ʻē aʻe i hiki ke kūpono a ʻaʻole pono paha. Pono e hoʻokumu ʻia nā kūlana o ka mālama e hōʻoia i ka hoʻōla kūpono a me ka detoxification. Pono e ho'āʻo ʻia nā ʻenehana no ka loiloi ʻana i ka holomua. Nā kuʻina a i ʻole nā ​​kaʻina hana e kōkua i ka hoʻoholo ʻana i ka wā kūpono ka mālama ʻana a i ka wā ʻaʻole pono e waiho ʻia no ka loiloi.

KE KULA

Ua hōʻike ʻia ka noiʻi ʻana ʻo ka hiki ʻana o nā cavitations iwi āwae kahi hana maʻi insidious e pili ana me ka emi ʻana o ke kahe koko. Hoʻopili ʻia ke kahe koko medullary e alakaʻi i ka mineralized maikaʻi ʻole a me ka lawa ʻole o ka vascularization ma nā wahi o ka iwi iwi i hiki ke loaʻa i ka maʻi pathogens, e hoʻonui ai i ka make cellular. ʻO ke kahe ʻana o ke koko i loko o nā maʻi cavitational hoʻohālikelike i ka lawe ʻana i nā lāʻau antibiotic, nā meaʻai a me nā ʻelele immune. Hiki nō hoʻi i ke kaiapuni ischemic ke hoʻopaʻa a hoʻolaha i nā mea hoʻopuʻi maʻi maʻi i loaʻa i nā hopena maikaʻi aʻe i ke olakino ʻōnaehana. ʻO ka predisposition genetic, ka hoʻemi ʻana i ka hana immune, nā hopena o kekahi mau lāʻau lapaʻau, trauma a me nā maʻi, a me nā mea ʻē aʻe e like me ka puhi ʻana e hiki ke hoʻoulu a hoʻolalelale paha i ka ulu ʻana o nā cavitations iwi āwae.

Me ka mea kālaiʻike iwi āwae koʻikoʻi, ʻo Kauka Jerry Bouquot, ke hōʻike nei ka IAOMT a me ka paipai ʻana i kahi hōʻailona histologically a pathologically pololei o nā maʻi cavitational iwi iwi e like me ka Chronic Ischemic Medullary Disease of the Jawbone, CIMDJ. ʻOiai he nui nā inoa, nā acronyms, a me nā huaʻōlelo i ka mōʻaukala a ke hoʻohana ʻia nei e hōʻike i kēia maʻi, ua manaʻo ka IAOMT ʻo kēia ka huaʻōlelo kūpono loa e wehewehe i ke kūlana pathologic a me ka micro-histologic maʻamau i loaʻa i nā cavitations iwi āwae.

ʻOiai ʻo ka hapa nui o nā ʻeha cavitational iwi he paʻakikī ke ʻike me nā radiograph maʻamau a ʻaʻole ʻeha ka hapa nui, ʻaʻole pono e manaʻo kekahi ʻaʻole i loaʻa ke kaʻina maʻi. Nui nā kaʻina maʻi paʻakikī e ʻike, a he nui nā mea ʻeha ʻole. Inā mākou e hoʻohana i ka ʻeha ma ke ʻano he hōʻailona no ka mālama ʻana, ʻaʻole mālama ʻia ka maʻi periodontal, ka maʻi diabetes a me ka hapa nui o nā maʻi kanesa. Loaʻa i nā kauka niho o kēia lā nā ʻano hana e mālama pono ai i nā cavitation iwi ā a me ka hōʻole ʻole ʻana i ka maʻi a me ka ʻōlelo ʻana i ka lāʻau lapaʻau ʻaʻole i emi iki ke koʻikoʻi ma mua o ka hiki ʻole ke ʻike a mālama i ka maʻi periodontal. No ke olakino a me ka maikaʻi o kā mākou poʻe maʻi, he mea koʻikoʻi ka hoʻololi paradigm no nā ʻoihana mālama ola āpau, me nā kauka niho a me nā kauka lapaʻau, i 1) ʻike i ka laha ʻana o nā cavitations iwi ā a me 2) hoʻomaopopo i ka pilina ma waena o nā cavitations iwi a me ka maʻi ʻōnaehana.

PAPA I

NANA IA IAOMT 2 HUINA (2023)

E like me ka mea i kūkākūkā pōkole ʻia ma ka pepa, hoʻokuʻu pinepine nā kūlana pili ʻole ma hope o ke kaʻina cavitation. No ka ʻike hou aku e pili ana i ke ʻano o nā kūlana e hoʻoholo ai a pehea e loaʻa ai ke kala kala kokoke e pili ana i ke ʻoki ʻana, ua hoʻouna ʻia kahi noiʻi lua i ka lālā IAOMT. He papa inoa o nā hōʻailona a me nā kūlana i ʻike ʻia e nā lālā o kēia kōmike e hoʻomaikaʻi ma hope o ka ʻoki ʻana i hōʻuluʻulu ʻia no ka noiʻi. Ua nīnau ʻia ka poʻe pane inā ua nānā lākou i kekahi o kēia mau kūlana e hoʻokuʻu ana ma hope o ke ʻoki ʻana, a inā pēlā i ka pae hea. Ua nīnau pū ʻia lākou inā ua hoʻokuʻu koke ʻia nā hōʻailona a i ʻole ua lōʻihi ka hoʻomaikaʻi ʻana ma mua o ʻelua mahina. Eia hou, ua nīnau ʻia ka poʻe pane inā hana maʻamau lākou i ke kaʻina ma nā pūnaewele hoʻokahi, nā pūnaewele unilateral lehulehu, a i ʻole nā ​​pūnaewele āpau i hoʻokahi ʻoki. Hōʻike ʻia nā hopena o ka noiʻi ma nā Kiʻi ma lalo nei. He mea hoʻomaka ka ʻikepili, no ka mea he liʻiliʻi ka helu o nā mea pane (33) a aia kekahi mau ʻikepili i nalowale.

Appx I Fig 1 Ua helu ka poʻe pane i ke kiʻekiʻe o ka hoʻomaikaʻi ʻana (maʻalahi, haʻahaʻa a koʻikoʻi paha) a ʻike i ka wikiwiki o ka holomua (0-2 mau mahina) a i ʻole ka lōʻihi (> 2 mau mahina). Ua helu ʻia nā kūlana/hōʻailona ma ka papa o ka hapa nui i hōʻike ʻia. E hoʻomaopopo i ka waiho ʻia ʻana o ka hapa nui o nā kūlana/hōʻailona ma lalo o ʻelua mahina (ʻaoʻao hema o ka laina waena).

Appx I Fig 2 E like me ka mea i hōʻike ʻia ma luna, i kekahi mau hihia, ʻaʻole i ʻike nā mea pane i ka manawa o ka hoʻihoʻi ʻana no nā hoʻomaikaʻi i ʻike ʻia.

Appx I Fig 3 Ua pane ka poʻe pane i ka nīnau, "Maʻamau ʻoe e paipai/hana

ʻO kahi ʻokiʻoki no nā pūnaewele hoʻokahi, nā pūnaewele unilateral i mālama pū ʻia, a i ʻole nā ​​​​pūnaewele āpau i mālama ʻia i hoʻokahi hana?"

HOOPII II

NANA IA IAOMT 1 HUINA (2021)

Ma muli o ka liʻiliʻi o nā palapala a me nā loiloi hihia lapaʻau e pili ana i ka mālama ʻana i nā maʻi cavitational, ua nānā ka IAOMT i kona lālā no ka ʻohi ʻana i ka ʻike e pili ana i nā ʻano a me nā lāʻau e ulu nei i kahi 'mālama maʻamau. Loaʻa ka noiʻi piha ma ka pūnaewele IAOMT (e hoʻomaopopo ʻaʻole i pane nā kauka a pau i nā nīnau noiʻi āpau).

No ka hōʻuluʻulu pōkole, ʻo ka hapa nui o nā mea pane 79 e hāʻawi i ka lāʻau lapaʻau, e pili ana i ka noʻonoʻo ʻana i ka ʻiʻo palupalu, ke komo ʻana i ke kahua cavitation, a me nā ʻano like ʻole o ka 'hoʻomaʻemaʻe kino' a me ka hoʻomaʻemaʻe ʻana i ka wahi i hoʻopilikia ʻia. Hoʻohana ʻia ka nui o nā lāʻau lapaʻau, nutraceuticals, a/a i ʻole nā ​​huahana koko no ka hoʻolaʻa ʻana i ka ʻeha ma mua o ka pani ʻana i ka ʻoki ʻana o ka ʻiʻo palupalu.

Hoʻohana pinepine ʻia nā rotary burs e wehe a komo i ka ʻeha iwi. Hoʻohana ka hapa nui o nā kauka lapaʻau i kahi mea hana lima e ʻoki ai i ka iwi maʻi (68%), akā hoʻohana ʻia nā ʻenehana a me nā mea hana ʻē aʻe, e like me ka rotary bur (40%), kahi mea piezoelectric (ultrasonic) (35%) a i ʻole ER: YAG laser (36%), ʻo ia ke alapine laser i hoʻohana ʻia no ke kahe ʻana o ka photoacoustic.

Ke hoʻomaʻemaʻe ʻia ka pūnaewele, hoʻomaʻemaʻe ʻia, a / a curette paha, hoʻohana ka hapa nui o ka poʻe pane i ka wai ozone/gas e hoʻomaʻemaʻe a hoʻoikaika i ka ho'ōla. 86% o nā mea pane e hoʻohana i ka PRF (platelet-rich fibrin), PRP (platelet-rich plasma) a i ʻole PRF ozonated a i ʻole PRP. ʻO kahi ʻano hana disinfecting hoʻohiki i hōʻike ʻia ma ka palapala a i loko o kēia noiʻi (42%) ka hoʻohana intraoperative o Er:YAG. ʻAʻole hoʻohana ʻo 32% o ka poʻe pane i kekahi ʻano o ke kālai iwi no ka hoʻopiha ʻana i ke kahua cavitation.

ʻO ka hapa nui o ka poʻe pane (59%) ʻaʻole lākou biopsy i nā ʻeha e hōʻike ana i nā kumu like ʻole mai ke kumu kūʻai, hiki ʻole ke loaʻa i nā laʻana o nā kiko ola, paʻakikī i ka ʻimi ʻana i kahi keʻena pathology, a i ʻole ka maopopo o ke kūlana o ka maʻi.

ʻAʻole hoʻohana ka hapa nui o ka poʻe pane i nā lāʻau antibiotic ma mua o ka hana (79%), i ka wā o ke kaʻina (95%) a i ʻole ma hope o ka hana (69%). ʻO nā kākoʻo IV ʻē aʻe i hoʻohana ʻia me nā steroid dexamethasone (8%) a me nā Huaʻa C (48%). Nui ka poʻe pane (52%) hoʻohana i ka haʻahaʻa haʻahaʻa laser therapy (LLLT) ma hope o ka hana ʻana no nā kumu hoʻōla. Nui ka poʻe pane ʻōlelo i ke kākoʻo meaʻai me nā huaora, nā minela, a me nā ʻano homeopathics ʻē aʻe ma mua o (81%) a i loko o (93%) o ka manawa ho'ōla.

PAUKU III

Images

Appx III Fig 1 Pane hema: 2D X-ray diagnostics of area #38. Pane akau: Ka palapala o ke akea o FDO) ma kahi retromolar 38/39 me ka hoʻohana ʻana i ka mea ʻokoʻa ma hope o ke kaʻina ʻana o FDOJ.

Nā pōā: FDOJ, momona degenerative osteonecrosis o ka iwi āwae.

Hoʻololi ʻia mai Lechner, et al, 2021. “Hoʻolaha ʻia ʻo Jawbone Cavitation RANTES/CCL5: Case Studies Linking Silent Inflammation in the Jawbone with Epistemology of Breast Cancer.” ʻO ka maʻi maʻi umauma: nā pahuhopu a me ka lāʻau lapaʻau

Appx 3 Fig 2 Ka hoʻohālikelike ʻana o ʻehiku cytokines (FGF-2, IL-1ra, IL-6, IL-8, MCP-1, TNF-a a me RANTES) ma FDOJ ma lalo o RFT #47 me nā cytokines i ka iwi iwi olakino (n = 19). Nā palapala i loko o ka hana o ka hoʻonui ʻia ʻana o FDOJ ma ka iwi ākau haʻahaʻa ʻākau, ʻāpana #47 apika o RFT #47, ma ka mea ʻokoʻa ma hope o ka wehe ʻana i ka RFT #47.

Nā pōā: FDOJ, momona degenerative osteonecrosis o ka iwi āwae.

Hoʻololi ʻia mai Lechner a me von Baehr, 2015. "Chemokine RANTES/CCL5 ma ke ʻano he loulou i ʻike ʻole ʻia ma waena o ka ho'ōla ʻana i ka ʻeha ma ka iwi iwi a me ka maʻi ʻōnaehana: He wānana a me nā lāʻau lapaʻau ma ka Horizon?" ʻO ka EPMA Journal

Appx III Fig 3 Ke kaʻina hana no ka retromolar BMDJ/FDOJ. Pane hema: ma hope o ka pelu ʻana i ka pā mucoperiosteal, ua hoʻokumu ʻia ka puka makani i loko o ka cortex. Pane ʻākau: curetted medullary cavity.

ailona: BMDJ, hemahema o ka iwi iwi ma ka iwi a; FDOJ, momona degenerative osteonecrosis o ka iwi āwae.

Hoʻololi ʻia mai Lechner, et al, 2021. “Chronic Fatigue Syndrome a me Bone Marrow Defects of the Jaw – He hōʻike hihia no nā mea hou aku no ka X-Ray Diagnostics me ka Ultrasound. Nūpepa Hoʻolaha Hoʻopiʻi Lapaʻau Kaiapuni

Appx III Fig 4 (a) Curettage o FDOJ ma ka iwi ā lalo me ke aʻalolo infra-alveolar denuded. (b) E pili ana i ka X-ray me ka ʻole o nā hōʻailona o ke kaʻina hana maʻi ma ka iwi āwae.

ailona: FDOJ, momona degenerative osteonecrosis o ka iwi ā

Hoʻololi ʻia mai Lechner, et al, 2015. "Peripheral Neuropathic Facial / Trigeminal Pain a me RANTES / CCL5 ma Jawbone Cavitation." Hōʻikeʻike a me nā mea'ē aʻe i hōʻikeʻia

Kiʻiʻoniʻoni Appx III 1

Paʻi wikiō (kaomi pālua i ke kiʻi e ʻike ai i ke kiʻi) o ka ʻoki iwi āwae e hōʻike ana i nā ʻōpū momona a me ka hoʻokuʻu purulent mai ka iwi ā o ka mea maʻi i manaʻo ʻia he necrosis iwi ā. Na Kauka Miguel Stanley, DDS

Kiʻiʻoniʻoni Appx III 2

Paʻi wikiō (kaomi pālua i ke kiʻi e ʻike ai i ke kiʻi) o ka ʻoki iwi āwae e hōʻike ana i nā ʻōpū momona a me ka hoʻokuʻu purulent mai ka iwi ā o ka mea maʻi i manaʻo ʻia he necrosis iwi ā. Na Kauka Miguel Stanley, DDS

No ka hoʻoiho ʻana a paʻi paha i kēia ʻaoʻao ma kahi ʻōlelo ʻē aʻe, e koho i kāu ʻōlelo mai ka papa kuhikuhi hāʻule i lalo ma ka ʻaoʻao hema mua.

Pepa Kūlana IAOMT ma nā mea kākau o nā iwi ā iwi