Ua loaʻa anei iā ʻoe ka lāʻau lapaʻau radiation no ke kanesa poʻo a me ka ʻāʻī? Ke hoʻopilikia nei anei ia i kou mau iwi? E aʻo kākou e pili ana i (Osteoradionecrosis - ORN)!

Ua loaʻa anei iā ʻoe ka ʻeha, ka pehu ʻana, a i ʻole ka ʻeha i loko o kou waha a i ʻole kou ʻāwae ma hope o ka hana ʻana i ka radiation therapy no ke kanesa poʻo a ʻāʻī paha? Malia paha ua hiki i ka manawa no ʻoe e aʻo e pili ana i kahi maʻi i kapa ʻia ʻo osteoradionecrosis. Mai hopohopo, e kamaʻilio mākou e pili ana i ia mea me nā kikoʻī a ma ke ʻano maʻalahi loa.

He aha ka Osteoradionecrosis (ORN)?

I ka ʻōlelo maʻalahi, ʻo ka osteoradionecrosis (ORN) ka make ʻana o nā hunaola iwi ma muli o ka ʻike ʻia ʻana i ka radiation. He kūlana ia e hiki ke hana ʻia ma ke ʻano he hopena ʻaoʻao o ka radiation therapy no ka maʻi kanesa, ʻoiai ke kanesa o ke poʻo a me ka ʻāʻī. E hoʻomanaʻo, ʻo ka radiation i hoʻohana ʻia e pepehi i nā hunaola kanesa hiki ke hōʻino i nā hunaola iwi olakino. Hiki ke hana ʻia i nā mahina a i ʻole nā ​​makahiki ma hope o ka loaʻa ʻana o ka radiation therapy.

ʻO ka maʻamau, hoʻopilikia kēia ʻano i ka iwi ʻāwae o lalo (mandibular osteoradionecrosis). Eia nō naʻe, hiki ke hana ia i loko o kekahi iwi i hōʻike ʻia i ka radiation, e like me ka iwi ʻāwae o luna (maxillary osteoradionecrosis) a i ʻole ka ʻaoʻao mua o ka iwi kuamoʻo (vertebral osteoradionecrosis). He mea kākaʻikahi loa, hiki i kēia ʻano ke hoʻopilikia i ka iwi poʻo, akā hiki ke ʻoi aku ka koʻikoʻi.

ʻO ka lāʻau lapaʻau radiation a me ke olakino o ka iwi - no ke aha e hana ai kēia?

I kēia manawa, e nānā kākou i ke kumu o kēia. Hoʻopōʻino ka radiation i nā kīʻaha koko palupalu e hoʻolako ana i ke koko i nā iwi. E like me nā ʻāpana ʻē aʻe o ko kākou kino, pono nā iwi i kahi lako koko maikaʻi e noho olakino a e ho'ōla koke inā ua hōʻino ʻia.

E noʻonoʻo wale, e like me ka lāʻau e mae ana me ka wai ʻole, inā ʻaʻole lawa ke koko i ka iwi, e nalowale nō hoʻi kona ola a hoʻomaka e make.

He aha ka mea e hana ʻia ke hoʻopilikia ʻia kēia lako koko?

• He maʻalahi nā iwi a me nā ʻiʻo a puni i ka maʻi.
• ʻAʻole hiki ke ho'ōla pono ʻia.
• Ke hoʻomaka nei e make mālie.

He mea palupalu loa ko kākou ʻauwae i kēia. ʻO kēia no ka mea he paʻakikī ke pale aku i ka radiation mai ka hiki ʻana i ka iwi ʻauwae i ka wā o ka radiation therapy no nā maʻi ʻaʻai poʻo a me ka ʻāʻī. Eia kekahi, ua hoʻonui hou ʻia ka pilikia o kēia `(ORN)` e nā bacteria e noho maoli ana i loko o ko kākou waha.

Hiki i ka hōʻino ʻana o ka radiation i loko o ka waha ke hana i nā mea e like me:

• Ka ʻike ʻia ʻana o ka iwi (ʻo ia hoʻi, ua ʻike ʻia ka iwi ma o nā ʻāʻī).
• ʻEha a me ka pehu ʻana i loko o ka ʻāwae i kekahi manawa.
• Loaʻa i kahi ʻeha e ho'ōla ʻole ana .

Pehea ka maʻamau o kēia ʻano?

Wahi a ka American Head & Neck Cancer Society, hiki ke loaʻa ka osteoradionecrosis ma waena o 4% a me 8% o ka poʻe me ka maʻi ʻaʻai poʻo a me ka ʻāʻī.

He aha nā hōʻailona o ka osteoradionecrosis (ORN)?

I kēia manawa, e nānā kākou i nā hōʻailona āu e ʻike ai i kēia kūlana. Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau mea, ʻoi aku ka maikaʻi o ka ʻimi ʻana i ke kōkua lapaʻau.

• He ʻeha a he ʻōpū paha ma waho o nā ʻāʻī, ka ʻāʻī, a i ʻole ka ʻauwae.
• ʻEha.
• Pehu.
• Ka maʻi (e like me ka pus).
• ʻAʻole kūpono ke kūlike ʻana o nā niho (malocclusion).
• He ʻano ʻūlili a ʻoniʻoni paha .
• Nā ʻāpana iwi e puka mai ana mai loko mai o ka waha.
• I kekahi manawa, ma lalo o ka ʻauwae, haki ka ʻili a puka mai ka iwi (ua kapa ʻia hoʻi kēia he "fistula").
• Ka haki ʻana o ka iwi ʻauwae.
• ʻO ka paʻa o nā ʻiʻo o ka ʻāwae e pale ai i ka waha mai ka wehe pono ʻana (trismus).

No ke aha e kū mai ai ka osteoradionecrosis (ORN)?

ʻO ke kumu nui, ʻo ia ka radiation therapy i ke poʻo a me ka ʻāʻī. He mea maʻamau kēia ʻano i ka poʻe i loaʻa nā nui radiation ma mua o 60 Gray (Gy) units. (ʻO Gy kahi ana no ka radiation).

Nā Kumu Pōpilikia o ka Osteoradionecrosis `(ORN)` - ʻO wai ka mea i ʻoi aku ka paʻakikī o ka loaʻa ʻana?

ʻOi aku ka pilikia o kekahi poʻe i ka loaʻa ʻana o kēia maʻi ma mua o kekahi. E nānā inā pili kēia mau ʻoiaʻiʻo iā ʻoe:

• Ka hoʻomaʻemaʻe waha maikaʻi ʻole (ʻaʻole e palaki pono i kou mau niho, ʻaʻole mālama i kou hoʻomaʻemaʻe waha).
• Inā ʻaʻole i hoʻoponopono pono ʻia nā pilikia niho (e like me nā lua a me nā maʻi ʻāʻī) ma mua o ka hoʻomaka ʻana o ka mālama ʻana i ka radiation.
• Inā loaʻa iā ʻoe ka waha maloʻo (xerostomia) ma hope o ka radiation therapy.
• Inā he ulia a ʻeha paha i ka ʻāwae ma hope o ka mālama ʻana i ka radiation, ʻoiai hoʻi i loko o ka makahiki mua.
• Inā ua unuhi ʻia kahi niho mai kahi i hoʻomālamalama mua ʻia.

E hoʻomanaʻo, hiki i kēia ʻano o ka osteoradionecrosis ke hana ʻia i nā makahiki he nui ma hope o ka loaʻa ʻana o ka lāʻau radiation no ke kanesa poʻo a me ka ʻāʻī.

Pehea e ʻike ʻia ai kēia?

ʻO ka maʻamau, hiki mai ka Osteoradionecrosis (ORN) i kekahi mau makahiki ma hope o ka radiation therapy. Inā kānalua kāu kauka i kēia, e hana ʻo ia i kahi hoʻokolokolo piha o kou poʻo a me kou ʻāʻī. E hoʻokaʻaʻike aku nō hoʻi ʻo ia i ke kauka radiation oncologist nāna i hāʻawi iā ʻoe i ka radiation therapy e ʻike i ka nui o ka radiation āu i loaʻa ai.

He aha nā hoʻokolohua e kōkua ai i ka hōʻoia ʻana?

No ka hōʻoia ʻana i ka maʻi, hiki i kāu kauka ke ʻōlelo i nā hoʻokolohua e like me:

• Nā kukuna X-niho.
• Hana ʻia kahi scan CT o ka ʻāwae (CT - computed tomography scan).
• Hiki ke hana ʻia kahi biopsy e nānā ai no ka hoʻi hou ʻana o ke kanesa.

He aha nā lāʻau lapaʻau no kēia?

ʻO ka mālama ʻana no ka osteoradionecrosis (ORN) e pili ana i ka nui a me ke koʻikoʻi o kou kūlana. ʻO ka mea nui loa, ʻo ia ka hoʻomaka ʻana i ka mālama ʻana i ka wā hikiwawe loa.ʻO ka wikiwiki o kou hoʻomaka ʻana i ka lāʻau lapaʻau, ʻoi aku ka maikaʻi o kou manawa e hoʻōla ai. Aia nā lāʻau lapaʻau ʻoki kino a me nā lāʻau lapaʻau ʻoki ʻole no kēia.

Hoʻokele ʻoki kino

Aia kekahi mau ʻokiʻoki i hana ʻia no kēia ʻano:

• Debridement ʻoki kino: ʻO kēia ka manawa e wehe ai ke kauka lapaʻau i ka iwi a me nā ʻiʻo make a maʻi paha, e like me ka hoʻomaʻemaʻe ʻana i kahi wahi maikaʻi ʻole.
• ʻO ke ʻoki hana hou ʻana o ka flap manuahi: He ʻoki hana paʻakikī iki kēia. Pili ia i ka lawe ʻana i nā kīʻaha koko, nā ʻiʻo, a me kahi ʻāpana iwi paha mai kahi ʻāpana ʻē aʻe o kou kino (no ka laʻana, he wāwae a lima paha) a hoʻoili iā ia i loko o ka ʻāwae i hōʻino ʻia.
• ʻO ALTFL (Anterolateral Thigh Fascia Lata Rescue Flap): He ʻano flap manuahi kēia. Ma kēia kaʻina hana, lawe ʻia kahi ʻāpana o ka ʻiʻo pili (fascia) mai ke kua o ka ʻūhā a hoʻoili ʻia. Ua nui nā vascularization o kēia ʻiʻo, e ʻae ana i ka wahi i hōʻino ʻia e loaʻa ka oxygen a me nā meaʻai. Ua hōʻike ʻia nā noiʻi hou he mea pono loa kēia ʻano hana i ka poʻe me ORN.
• Hoʻopili iwi piha: Hoʻohana ʻia kēia kaʻina hana kuʻuna i ka wā he nui ka iwi make, ʻoi aku hoʻi ma ka ʻāwae lalo. Ma kēia kaʻina hana, wehe loa ʻia ka iwi i hōʻino ʻia a hoʻopili ʻia kahi ʻāpana manuahi me ka iwi ma kona wahi. ʻOiai he kaʻina hana holomua kēia, he hana nui ia. Hiki iā ia ke hopena i kahi noho lōʻihi ma ka haukapila a me ka manawa hoʻōla lōʻihi. No laila, hoʻāʻo nā kauka e ʻike a mālama i kēia maʻi i ka wā hikiwawe loa.

Hoʻokele ʻoki ʻole

Aia kekahi mau lāʻau lapaʻau ʻokiʻoki ʻole:

• Nā lāʻau antibiotic: Inā he maʻi i loko o ka iwi a i ʻole nā ​​​​ʻiʻo a puni, e kuhikuhi kāu kauka i nā lāʻau antibiotic.
• `(PENTOCLO)`: : `(pentoxifylline)`, ( E - `tocopherol (vitamin E)`), ‍ `(clodronate)`. . ( E) ‍ . ‍ . ‍ ( `(PENTO)` ).
• ʻO ka lāʻau lapaʻau oxygen hyperbaric (Hyperbaric oxygen - HBO - lapaʻau):Hoʻohana kekahi mau kauka i kēia lāʻau lapaʻau e wikiwiki ai ke kaʻina hana ho'ōla o ke kino. Ma kēia, ua hoʻokomo ʻia ʻoe i loko o kahi keʻena kūikawā a hana ʻia e hanu i ka oxygen maʻemaʻe. ʻOi aku ka nui o ka oxygen i loko o ke keʻena ma kahi o ʻekolu manawa ma mua o ke kaiapuni maʻamau. ʻO ka pahuhopu nui ka hoʻohui ʻana i ka oxygen lawa i ke koko e hoʻoponopono i nā ʻiʻo i hōʻino ʻia. Eia nō naʻe, aia nā manaʻo like ʻole ma waena o ke kaiāulu lapaʻau e pili ana i kēia lāʻau lapaʻau "Hyperbaric oxygen". ʻOiai ua hoʻohana ʻia ia ma ke ʻano he lāʻau lapaʻau maʻamau ma kekahi mau kikowaena, ʻaʻohe mau haʻawina i kāohi ʻia i hōʻoia i kona holomua.

Hiki ke pale ʻia ka osteoradionecrosis (ORN)?

ʻAʻole hiki ke pale ʻia kēia ʻano i nā manawa a pau, akā ma mua o kou hoʻomaka ʻana i ka mālama ʻana i ka radiation i kou poʻo a i ʻole kou ʻāʻī, e kamaʻilio kāu kauka me ʻoe e pili ana i nā ala e hōʻemi ai i kēia pilikia.

Ma mua o ka hoʻomaka ʻana i ka hana radiation, pono ʻoe e hana i kēia mau mea:

• E kipa aku i ke kauka niho , e hoʻomaʻemaʻe pono i kou waha, a e hana i kahi nānā piha .
• E hana i kekahi lapaʻau niho (e like me nā hoʻopihapiha, ka unuhi ʻana i nā niho).
• E hoʻomaka i ka lāʻau lapaʻau fluoride i kēlā me kēia lā.

Pono ʻoe e hana i kēia mau mea i ka wā a ma hope o ka mālama ʻana i ka radiation:

• E mālama i ka maʻemaʻe waha maikaʻi (e palaki i kou mau niho i ʻelua manawa i ka lā, e hoʻomaʻemaʻe ma waena o kou mau niho).
• E hoʻēmi i nā meaʻai a me nā mea inu kō .
• E ʻike pinepine i kāu kauka niho no ka nānā ʻana a hoʻomaʻemaʻe i kou waha.
• E kiʻi koke i ka lāʻau no kekahi mau pilikia niho hou .
• E hoʻomau i ka mālama ʻana me ka fluoride i kēlā me kēia lā.

Pehea ka wikiwiki o ka laha ʻana o ka osteoradionecrosis (ORN)?

I ka hapanui o nā hihia, ulu mālie ka osteoradionecrosis (ORN). Hiki ke hala i kekahi mau makahiki no ʻoe e hoʻomohala i nā hōʻailona.

Hiki ke ho'ōla ʻia ka osteoradionecrosis (ORN)?

ʻOiai ʻaʻole hiki i nā kauka lapaʻau ke hoʻōla hou i ka iwi make, hiki i ka lāʻau kūpono ke hoʻōki i ka holomua o ka osteoradionecrosis (ORN). Ua ʻōlelo ʻia inā hoʻomaka mua ka lāʻau, hiki ke hoʻōki ʻia ke kūlana ma 96% o nā hihia .

No laila, inā loaʻa iā ʻoe ka osteoradionecrosis (ORN), ʻo ka hoʻomaka mua ʻana i ka mālama ʻana kou manawa kūpono loa no ka holomua. Hiki ke pōkole kāu ʻoki ʻana, a hiki paha iā ʻoe ke ho'ōla koke. ʻO ka wikiwiki o kāu mālama ʻana (ORN), ʻoi aku ka maikaʻi.

Ka Wānana o ka Osteoradionecrosis (ORN)

He maʻi hiki ke mālama ʻia ka Osteoradionecrosis (ORN). ʻO ke ʻano o ka lāʻau e pono ai ma muli o ka wahi o ka iwi i hōʻino ʻia, ka nui o ka make ʻana o ka iwi, a me nā lāʻau āu i hoʻāʻo ai ma mua.

Ma keʻano laulā, ʻo ka liʻiliʻi o ka wahi i hōʻino ʻia ai ka iwi, ʻoi aku ka maikaʻi o ka manawa e hoʻōla ai me ka ʻole o ke ʻoki kino nui. ʻAʻole paha e pane kekahi mau hihia o ORN i nā lāʻau lapaʻau liʻiliʻi a hiki ke holomua i ka maʻi iwi (osteomyelitis) a i ʻole nā ​​haki iwi. I ia mau hihia, pono paha nā kauka ʻoki e hana i kahi ʻoki kino nui (free flap).

Āhea wau e ʻike ai i ke kauka?

Inā ua loaʻa iā ʻoe ka radiation therapy ma kou poʻo a ʻāʻī paha ma mua a hoʻomaka ʻoe e ʻike i nā hōʻailona e like me ka ʻeha, ka pehu ʻana, a i ʻole ka palapū, e ʻike koke i kāu kauka. Hiki iā lākou ke hōʻoia he osteoradionecrosis (ORN) kou a hoʻomaka koke i kekahi lāʻau lapaʻau e pono ai.

He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?

Inā ua ʻike ʻia ʻoe a i ʻole kahi mea aloha me ka osteoradionecrosis (ORN), makemake paha ʻoe e nīnau iā ʻoe iho i kēia mau nīnau:

• Pehea ka mamao i laha ai kēia necrosis iwi?
• He aha nā koho lapaʻau e loaʻa iaʻu?
• E pono anei iaʻu ke ʻoki kino?
• He aha koʻu manaʻo (hiki ke ho'ōla ʻia)?

ʻO ka mea hope loa, e hoʻomanaʻo (Leka Lawe-Home)

He hopena koʻikoʻi ka Osteoradionecrosis (ORN) o ka radiation therapy i ke poʻo a me ka ʻāʻī. Hiki ke hala nā makahiki no ka ʻike ʻia ʻana o nā hōʻailona. ʻOiai ʻaʻole hiki ke "ho'ōla loa ʻia" ka ORN, hiki ke mālama ʻia me ka lāʻau lapaʻau. Aia nā hopena i ka wahi o ka iwi i hōʻino ʻia, ka nui o ka make ʻana o ka iwi, a me ke koʻikoʻi.

Inā loaʻa iā ʻoe ka ʻeha, ka pehu ʻana, ka ʻike ʻia ʻana o ka iwi, a i ʻole nā ​​hōʻailona ʻē aʻe o ka osteoradionecrosis, e ʻike koke i ke kauka. Hiki iā lākou ke ʻōlelo i ka lāʻau kūpono a kōkua iā ʻoe e hoʻokele i kou kūlana. ʻO ka mālama ʻana i ka hoʻomaʻemaʻe waha maikaʻi a me ka ʻike pinepine ʻana i kāu kauka niho he mea nui ia no ka pale ʻana a me ka ʻike ʻana i kēia kūlana i ka wā mua.

ʻOsteoradionecrosis , ORN, nā hopena ʻaoʻao o ka radiation therapy, maʻi iwi ʻāwae, mālama ʻana i ke kanesa, make ʻana o ka iwi, olakino waha