Dry Socket (Alveolar Osteitis) vs Post-Extraction Infection: Tsiku 3 mpaka 5 Kupweteka kwa Khutu ndi Kusamalira¶

Pambuyo pochotsa dzino, makamaka m'munsi mwachitatu molar (dzino lanzeru), fupa lopanda kanthu la nsagwada limachiritsa pokhapokha ngati magazi athanzi, ofiira ** fibrin magazi adzaza zitsulo ndikukhalabe ngati scaffold ya biological kwa minofu yatsopano ya granulation ndi kukula kwa fupa. Pakati pa **Tsiku la 3 ndi Tsiku la 5 pambuyo pochotsa **, komabe, zovuta ziwiri zosiyana zimatha kuchitika: alveolar osteitis (socket youma), kusungunuka kwa fibrinolytic kosapatsirana kapena kutulutsa magazi kumatuluka komwe kumasiya maliseche, kukhudzidwa kwambiri fupa la alveolar ** fupa la alveolar ndi mabakiteriya otulutsa mpweya, mabakiteriya otulutsa mpweya ndi mabakiteriya. matenda ozama mumlengalenga (subperiosteal, submandibular, pterygomandibular, kapena Ludwig angina). Odwala omwe ali ndi socket youma amakumana ndi njira yodziwika bwino yachipatala: 2 kwa masiku 4 a machiritso abwinobwino akutsatiridwa ndi kuyambika kwadzidzidzi ** koopsa, kozama, kugunda kwa 10/10 ululu wa neuralgic womwe umatulutsa nsagwada m'khutu, kachisi, diso, ndi khosi **, limodzi ndi kulawa koipa ndi fungo (**halitosis **) ndi kusonyeza fupa loyera, lopanda kanthu, lopanda kanthu. mafinya, kapena kufutukula kutupa kumaso **. Mosiyana ndi zimenezi, matenda enieni a bakiteriya a fascial amachititsa ** kupitirira kwa tsaya lakunja kapena kutupa pansi pa chibwano, kutentha thupi, kutuluka kwa purulent, kuvutika kumeza, ndi kuwonjezereka kwa lockjaw (trismus) ** zomwe zingathe kusokoneza mpweya mkati mwa maola. Ngati wina atachotsa dzino ayamba kutupa pansi pa chibwano kapena lilime, kuvutika kumeza malovu, kusalankhula mawu osamveka bwino, kapena kupuma movutikira, imbani foni kwanuko. manambala angozi nthawi yomweyo. Onaninso maupangiri a abale athu pa Ludwig angina ndi matenda ozama mano, kugwetsa mano ndi kuvulala kwa mano,ndi sepsis ndi septic shock.

Chofunikira chanu mwachangu ndikuwunika zizindikiro za mabakiteriya ofiira (kutentha thupi, kufutukuka kwa khosi kapena kutupa pansi pakamwa, mafinya, kapena trismus yoopsa), tengani klzzwxh:0008 madzi ** (osalavulira mwamphamvu, osayamwa mapesi kapena ma vapes, ndipo ** musamasese syringe yothirira ya pulatiki muzitsulo zatsopano m'masiku 5 oyambirira ), ndipo funsani dokotala wanu wa opaleshoni wamkamwa kapena dokotala wa mano kwa ** 5-minute eugenol medicated dressing place yomwe imachepetsa ululu wouma m'kati mwa mphindi.

Chitani izi tsopano¶

1. Yang'anani nthawi yomweyo kuti muwone mbendera zofiira za Deep Neck Space Infection zomwe zikuwopseza moyo ndikuimbira foni nambala yanu yazadzidzi kapena pitani kuchipatala ngati zilipo. Imbani 911 ku United States ndi Canada, 999 ku United Kingdom, 112 kudutsa European Union, 000 ku Australia, kapena onani chikwatu chathu chapadziko lonse lapansi cha manambala angozi ngati wodwala ali ndi **kutupa kufalikira pansi pa nsagwada kapena chibwano (malo a submandibular), kukwera kapena kulimba kwa pansi pakamwa pansi pa lilime, kudontha kapena kumeza malovu, mawu osamveka a mbatata, kutsekeka kwakukulu (kutsegula pakamwa kosakwana 1 mpaka 2 m'lifupi-zala), kudumpha malungo ndi kutsekeka kwa maso, * * kutupa.
2. Yang'anani mkati mwa socket yotulutsa ndi tochi (popanda kulowetsa chilichonse mu dzenje) ndipo fufuzani tsiku la post-op. Ngati muli pa Tsiku 3, Tsiku la 4, kapena Tsiku la 5 mutachotsa, musakhale ndi** malungo ndipo mulibe kutupa kwakunja kumaso , koma mwadzidzidzi munayamba ** ululu wopweteka kwambiri womwe umatuluka m'khutu lanu, kuwoneka koyipa kapena kachisi ** fupa lotuwa-loyera m'malo mwa kuundana kwakuda, mumakhala ndi ** socket youma (alveolar osteitis)**.
3. OSATI KUKULA thonje, zotokosera m'mano, zikhadabo, mapiritsi a aspirin, kapena mafuta a clove osasungunuka akutsikira m'chibowo chotsegula, ndipo MUSAMAgwiritse ntchito syringe yokhotakhota ya pulasitiki m'masiku 5 oyambirira. Kumenyetsa syringe ya pulasitiki ya Monoject molunjika m'mphako mkati mwa maola 72 mpaka 120 oyambirira kuphulika magazi amaphulika; ndi kuika aspirin wosweka piritsi kapena undiluted clove mafuta pa anabala alveolar fupa kumayambitsa kwambiri mankhwala osteonecrosis ndi mucosal amayaka.
4. Tengani pakamwa pawiri-action analgesia (Ibuprofen + Acetaminophen / Paracetamol) mwamsanga pamene mukukonzekera ulendo wa tsiku lomwelo kwa dokotala wanu wa mano kapena opaleshoni yapakamwa. Chifukwa ululu wouma wa socket umayendetsedwa ndi **kinin ndi prostaglandin synthesis ** mkati mwa fupa lowonekera, kuphatikiza anti-inflammatory toibun *60 mg NSAID *60 toibun *60 mg iliyonse Maola 8 ndi chakudya, ngati sichinatsutsidwe) ndi acetaminophen / paracetamol (500 mpaka 1,000 mg) imapereka mpumulo wamphamvu kwambiri kuposa mankhwala okhawo (ndipo amaposa codeine yapakamwa kapena hydrocodone chifukwa cha ululu wa mafupa a mano).
5. klzzwxh:0029 Sungunulani **theka la supuni ya tiyipuni (2.5 magalamu) ya mchere wa patebulo mu gali (240 mL) la madzi ofunda**. Ingomwani pang'onopang'ono, ** tembenuzirani mutu wanu pang'onopang'ono kumbali yochotsamo ** kotero kuti madzi ofunda amchere atseke pazitsulo kwa masekondi 30, ndiye ** tsamirani patsogolo pa sinki ndikutsegula pakamwa panu kuti madzi atuluke ndi mphamvu yokoka **. Osatupa masaya anu kapena kulavulira mwamphamvu, chifukwa kuthamanga kwapakamwa koyipa kumayamwa magazi otsala.
6. Imbani dokotala wamano kapena ochita opaleshoni yapakamwa amene adachotsa dzinolo kwa mphindi 5 za Medicated Dry Socket Paste / Dressing placement. Socket youma ndi si kuchiritsidwa ndi maantibayotiki amkamwa; chithandizo chotsimikizirika ndi ulendo waufupi, wopanda ululu wopita ku ofesi komwe dotolo amatsuka chakudya chotsekereza pang'onopang'ono ndi saline yotentha ndikuyika phala la eugenol/guaiacol/benzocaine medicated phala (Alveogyl, Alvogyl, kapena Zinc-Oxide Eugenol Eugenol kutsekera m'makutu) mpaka mphindi 15*.

Mtengo wachigamulo: kupweteka kwapambuyo pa Tsiku 1 mpaka 10 (machiritso wamba vs socket youma vs abscess fascial)¶

flowchart TD
    A["Kupweteka, kulawa koipa, kutuluka magazi, kapena kutupa pambuyo pochotsa dzino"] --> B{"Ma Airway kapena Deep Fascial Red Flags? (Kutupa pansi pa chibwano, kukweza lilime pansi, kudontha, kutentha thupi, trismus yayikulu)"}
    B -->|Yes: Deep Fascial Space Infection or Ludwig's Angina| C["Imbani EMS kapena pitani ku Chipatala ED mwamsanga: IV maantibayotiki + chitetezo cha airway + ngalande ya opaleshoni"]
    B -->|No airway signs, no high fever, no expanding neck swelling| D{"Kodi ndi tsiku liti lomaliza kuchotsa ndipo mukuwona chiyani?"}
    D -->|Day 1 to 2: Moderate soreness, mild pink saliva oozing, soft cheek swelling peaking at 48 hrs| E["Normal Post-Operative Kutupa: kuluma pa yopyapyala yopyapyala yopyapyala kapena thumba lakuda tiyi chifukwa kuchucha; ayezi paketi woyamba maola 24; NSAID + acetaminophen"]
    D -->|Day 2 to 5: White or yellowish-cream soft film covering the socket WITH IMPROVING pain| F["Normal Fibrin Granulation Tissue (OSATI mafinya, OSATI zitsulo zouma): zisiyeni zokha"]
    D -->|Day 3 to 5: Sudden 10/10 throbbing pain radiating to ear and temple + foul odor + empty socket / bare bone| G["Dry Socket (Alveolar Osteitis): kutayika kwa fibrinolytic kwa magazi"]
    D -->|Day 4 to 10: Localized gum swelling, throbbing pain, yellow pus discharge, low-grade fever| H["Localized Post-Extraction Subperiosteal kapena Vestibular Abscess"]
    D -->|Weeks 1 to 4: Small sharp white bone sliver poking through healing gum| I["Bony Sequestrum / Alveolar Spicule: ofesi yaying'ono yosalala kapena kuthamangitsidwa mwachisawawa"]
    G --> J["Kusamba kwamadzi amchere ofunda kumutu (osalavula); ibuprofen + acetaminophen; Osagwiritsa ntchito syringe msanga"]
    J --> K["Kuyendera kwa Mano a Tsiku lomwelo / Opaleshoni Opaleshoni: Kupaka mchere wofatsa + Alveogyl / Eugenol kuvala mankhwala"]
    H --> L["Ulendo Wachangu wa Mano / OMFS: intraoral incision & drainage + socket curettage + oral amoxicillin/metronidazole"]

Kusiyanitsa kwachipatala: Soketi Yochiritsira Yachibadwa vs Dry Socket vs Post-Extraction Bacterial Infection¶

Pathophysiology: Chiphunzitso cha Birn's Fibrinolytic ndi chifukwa chake mano anzeru otsika amakhala osatetezeka 10x¶

Ngakhale kuyamwa kwamakina (kusuta, kupopera, kulavulira, kapena kuponya syringe koyambirira) ndikoyambitsa kwambiri, kafukufuku wa Dr. H. Birn adawonetsa kuti njira yayikulu ya alveolar osteitis ndi biochemical localized fibrinolysis:

1. Birn's Fibrinolytic Cascade M'kati mwa Mafupa a Alveolar¶

1. Kupanga Kwa Ziphuphu (Tsiku 1): Dzino Likangotuluka, magazi amadzaza fupa la mafupa (alveolus) ndipo prothrombin imatembenuza fibrinogen kukhala fibrin meshwork yolumikizana ndi mtanda yomwe imatsekera maselo ofiira a magazi ndi mapulateleti, kusindikiza fupa laiwisi.
2. ** Kutulutsidwa kwa Oyambitsa Matenda a Mafupa Kuchokera ku Bone Trauma ndi Mabakiteriya (Masiku 2 mpaka 4):** Pamene kuchotsa kumafuna opaleshoni kuchotsa mafupa (osteotomy ndi kubowola), kukweza mizu mwamphamvu, kapena kumachitika pamaso pa pericoronitis kapena mabakiteriya a periodontal (monga *Treponema *Treponema dentivalicola) Maselo am'mafupa a alveolar ndi ma anaerobic oral bacteria amatulutsa minolo ya plasminogen activator (tPA) ndi bacterial fibrinolysins.
3. Kutembenuka kwa Plasminogen kukhala Plasmin (Kuwonongeka kwa Clot): Ma plasminogen activators amasintha plasminogen yosagwira ntchito (yotsekeredwa mkati mwa clot) kukhala puloteni yogwira ntchito ya proteolytic plasmin, yomwe imasungunula mwadongosolo ulusi wa fibrin womwe umagwira magazi pamodzi. Pofika Tsiku lachitatu mpaka Tsiku 4, magazi osungunuka amatsuka m'malovu, kusiya mbale yaiwisi cribriform plate (lamina dura) ya fupa la alveolar maliseche kwathunthu kumadzi am'kamwa, mpweya, ndi chakudya.
4. Chifukwa Chake Mafupa Oonekera Amayambitsa Kupweteka kwa Khutu (Kupanga Kinin): Enzayinemu ya plasmin yomweyi yomwe inasungunula magazi a fibrin amadulanso kininogen mu bradykinin, imodzi mwa mamolekyu amphamvu kwambiri omwe amachititsa ululu mu biology yaumunthu. Bradykinin ndi prostaglandins zimalimbikitsa mwachindunji minyewa yopanda kanthu, yopanda myeli inferior alveolar nerve (CN V3) mathero akudutsa pakhoma lowonekera. Chifukwa ** auriculotemporal nerve ** (yomwe imapereka chidziwitso ku ngalande yakunja ya khutu, eardrum, ndi kachisi) imachoka chimodzimodzi ** mandibular kugawikana kwa mitsempha ya trigeminal (CN V3) ** monga mitsempha yapansi ya alveolar, ubongo wa wodwalayo umawona chizindikiro chachikulu cha fupa monga *, kupweteka kwa diso * kuwombera khutu, kupwetekedwa kwa kachisi. otalgia).

2. Chifukwa Lower Nzeru Mano Akaunti Kuposa 80% All Dry Sockets¶

Socket youma ndi ** kuwirikiza ka 10 kunsi kwa nsagwada (mandible), makamaka m'munsi mwachitatu molar (dzino lanzeru) *, kuposa mano apamwamba pazifukwa zitatu za anatomical: - Bone Lalifupi La Cortical Lokhala Ndi Magazi Osakwanira: Chibwano chapamwamba (maxilla) chimakhala ndi fupa la spongy, lomwe limatuluka magazi kwambiri komanso limalimbitsa magazi. Nsagwada zam'munsi zam'munsi ( mandible pamtunda wa oblique wakunja) zimakhala ndi ** wandiweyani,andiweyani, wosasunthika bwino wa cortical fupa ndi mitsempha yochepa kwamri ya magazi kuti ikhazikike ndi kudyetsa magazi. - Kuchotsa Mafupa Ochita Opaleshoni ndi Kuyang'ana Mphepete: Mano anzeru otsika nthawi zambiri amafunikira opaleshoni ya mucoperiosteal flap, kubowola mafupa mozungulira, ndi kudula mano, komwe kumatulutsa ma plasminogen ambiri a m'mafupa. - Gravity Food-Trap Geometry: Soketi ya mano yam'mwamba imayang'ana pansi, kotero mphamvu yokoka imatulutsa tinthu tambiri tomwe timadya. Chitsulo cha mano chocheperako ndi kapu yoyang'ana m'mwamba pomwe pakona yakumbuyo kwa tebulo lotafunidwa, komwe kumatafunidwa ndi malovu pamwamba pa clot ndikulowetsa mabakiteriya a fibrinolytic.

3. Zowopsa 6 Zazikulu Zomwe Zimachulukitsa Chiwopsezo Chowuma¶

1. Kusuta Fodya, Kusuta (Ndudu za E-Cigarette), kapena Chamba mkati mwa Maola 72 mpaka 120 (Kumawonjezera chiopsezo kuwirikiza katatu mpaka 5): Nikotini vasoconstricts gingival ndi ma capillaries a m'mafupa, mpweya wa cytotoxic umapha fibroblasts ndi osteoblasts zomwe zimatulutsa ndudu za ndudu zomwe zimakoka ndudu, ndikujambula ndudu za ndudu zomwe zimakoka. kutseka kwa soketi.
2. Mapiritsi Olerera M'kamwa (Estrogen) ndi Nthawi Yakutha Kwa Msambo (Imawonjezera chiopsezo 2-kuwirikiza katatu): Exogenous estrogen m'magulu oletsa kulera a pakamwa amathandizira kuphatikizika kwa chiwindi kwa plasminogen ndikuwonjezera fibrinolytic ntchito (kusungunula magazi mwachangu). Amayi omwe amamwa njira zakulera zapakamwa amakhala ndi 20% mpaka 30% ya socket youma pambuyo pa opaleshoni yotsika ya mano, yomwe imatha kuchepetsedwa pokonza zochotsa mwapadera mkati mwa Masiku 23 mpaka 28 a piritsi (pamene milingo ya estrogen imakhala yotsika kwambiri).
3. Kuthirira Sirinji ya Pulasitiki Asanakwane (Tsiku la 5 mpaka 7 Lisanakwane): Madokotala ochita opaleshoni nthawi zambiri amapatsa odwala syringe ya pulasitiki yopindika (Monoject 412) kuti atulutse chakudya kuchokera m'mabowo a mano ochepa. **M'masiku oyambirira a 5, chivundikirocho sichinasinthe kukhala minofu yolimba ya granulation; Kuthira jekeseni m’mphako Tsiku la 5 mpaka 7 lisanachitike, magaziwo amaundana ndipo kumapangitsa kuti phata louma nthawi yomweyo.
4. Kulavulira Moumiriza, Kusambira Molimba M'kamwa, Kapena Kumwa Udzu M'maola 72 Oyambirira: Kumapangitsa kuti madzi asayende bwino pa soketi.
5. Zotsukira Mkamwa Zokhala ndi Mowa (Listerine) kapena Mafuta a Hydrogen Peroxide mu Sabata 1: Mowa wochulukira kwambiri komanso hydrogen peroxide wothimbirira umatulutsa maselo ofiira am'magazi ndikusungunula magazi oyambilira a fibrin.
6. Pericoronitis yomwe ilipo kale kapena Periodontal Infection mozungulira dzino lanzeru: Kuchuluka kwa anaerobic Treponema denticola kumatulutsa michere yolunjika ya fibrinolytic mu socket.

Kodi chinthu choyeracho ndi Dry Socket, Pus, kapena Normal Healing Granulation Tissue?¶

Patsiku lachitatu kapena 4 mutachotsa, odwala nthawi zambiri amawona ** zoyera zofewa, zamtundu wa kirimu, kapena zachikasu-zotuwa zikudzaza thumbalo ** ndikuganiza kuti zawonekera fupa loyera (soketi yowuma) kapena mafinya omwe ali ndi kachilombo.

Pang'onopang'ono chipatala komanso kasamalidwe kanyumba ka Dry Socket¶

1. Chifukwa Chake Muyenera Kuyimbira Dokotala Wanu Wamano Kapena Opaleshoni Yapakamwa (Machiritso a Mphindi 5)¶

• Zomwe dotolo wamano amachita: Kukumana kumatenga mphindi zosakwana 5 ndipo nthawi zambiri kumafuna palibe singano kapena kubowola.
• Dotolo wamano kapena maopaleshoni amkamwa amagwiritsa ntchito cannula yopindika yokhotakhota kutulutsa pang'onopang'ono tinthu tating'ono ta zakudya zowola m'soketi ndi kutentha (37 digiri Celsius / 98.6 degrees Fahrenheit) wosabala 0.9% saline kapena 0.12% chlorhexidine. Ma AAOMS apano ndi malangizo a Cochrane amalangiza mosamalitsa ** motsutsana ndi kuchiritsa koopsa kwa opaleshoni (kukwapula fupa lopanda kanthu kuyesa kutulutsanso magazi) **, chifukwa kukanda fupa lopanda kanthu lomwe latupa limayambitsa kupweteka kwambiri, kumawononga osteoblasts omwe atsala, ndikuchedwa kuchira.
• Kenako, sing'angayo amanyamula zitsulozo ndi chovala chapadera cha sedative obtundent dressing, nthawi zambiri Alveogyl/Alvogyl (mankhwala odzichotsera okha omwe ali ndi eugenol [analgesic], butamben [mankhwala oletsa ululu], ndi iodoformuted]gen, orantimicrobial eugenol [antimicrobial eugenol]** [antimicrobial eugenol]** siponji, kapena chingwe chopyapyala chosasunthika chokutidwa mu Zinc Oxide Eugenol + Benzocaine).
• Chithandizo Chaposachedwa: Chifukwa kuvala kumamatira fupa lopanda mpweya ndi malovu pamene mukusamba minyewa yamtundu wa trigeminal mu eugenol ndi mankhwala oletsa ululu wamba, 80% mpaka 95% ya ululu wa khutu ndi nsagwada zimatha mkati mwa mphindi 5 mpaka 15.
• Ngati chingwe chopyapyala chosasunthika chinagwiritsidwa ntchito, dokotala wa mano amachotsa kapena kusintha pambuyo pa **48 kwa maola 72 **; Maphala odzipha okha monga Alveogyl amatsuka okha pang'onopang'ono pamene minofu ya granulation imakula pansi pa **7 mpaka 10 masiku **.

2. Safe Home First Thandizo Usikuuno (Pamene Ofesi Yamano Yatsekedwa Mpaka Mmawa)¶

Ngati ululu wowuma pazitsulo ukafika usiku ndipo mwatsimikizira kuti palibe zizindikiro zofiira za bakiteriya (palibe kutentha thupi, kutupa pansi pa chibwano, palibe vuto la mpweya kapena kumeza):

1. Imwani Zomwe Zakonzedwa Panjira Yapawiri-Pathway Oral Analgesia (NSAID + Acetaminophen): Tengani Ibuprofen 400 mpaka 600 mg (kapena Naproxen 220 mpaka 500 mg) ndi chakudya KUPANDA *Acetaminophen (Paracetamol) 500 mpaka 1,000 mg uliwonse, kapena mutengere limodzi maola 3,000 palibe zilonda zam'mimba, matenda a impso, matenda a chiwindi, kugwiritsa ntchito anticoagulant, kapena ziwengo za NSAID.
2. Kusamba Kwamchere Wopanda Kutentha Kwambiri Kumutu: Sakanizani theka la supuni ya tiyi ya mchere mu 240 mL (8 oz) yamadzi ofunda (kapena gwiritsani ntchito mankhwala 0.12% mpaka 0.2% Chlorhexidine Gluconate mouthwash ngati akuuzani dokotala wanu). Sip, pendekeka mutu wanu kuti madzi otentha asambe soketi kwa masekondi 30 kuti ayandame pazakudya za acidic, ndipo mulole madziwo agwere mu sinki popanda kulavula.
3. Kusamala Zadzidzidzi Eugenol (Mafuta a Clove) Cotton Pellet: Ngakhale **mafuta opanda clove osatsukidwa sayenera kutsanuliridwa muzitsulo **, ngati muli ndi osabala OTC mano osakhalitsa kit yomwe imaphatikizapo diluted eugenol ndi thonje pellets (kapena sakanizani **1 dontho la clove mafuta ndi 3 mpaka 4 mafuta), mukhoza kugwetsa mafuta a maolivi 3 mpaka 4 Yatsani thonje losabala lomwe lili lalikulu kuposa potsegulira soketi ndikupumula pang'onopang'ono pamwamba pa soketiyo kwa mphindi 15 mpaka 30 kuti dzanzi minyewa, kenaka chotsani musanagone ndikuwona dokotala wamano m'mawa.
4. Kuzizira Kozizira Kwambiri Kuponderezana Kwakunja ndi Kukwezeka kwa Mutu: Pa **maola 24 mpaka 48 oyambilira ** mutatha kuchotsa, gwiritsani ntchito ** paketi ya ayezi ** (Mphindi 20 kupitirira, mphindi 20) kunja kwa tsaya. Kuyambira pa Tsiku la 3 mpaka Tsiku la 5 (pokhapo ngati **ziro matenda a bakiteriya kapena kutupa ** alipo), ** nsalu yonyowa yofunda yofunda ** kunja kwa minofu ya nsagwada imathandizira kupumula kwachiwiri kwa masseter spasm. **Gonani mutu wanu uli pamwamba pa mapilo awiri ** kuti muchepetse kuthamanga kwa mafupa.

Zina ziwiri zodziwika zadzidzidzi pambuyo pochotsa: Kutuluka magazi kwachiwiri (kutsekeka kwachiwindi) ndi Sharp Bone Spicules¶

1. Kutaya kwa magazi pambuyo pochotsa ndi kutsekeka kwa chiwindi (Maola 4 mpaka 24 kapena Tsiku 5 mpaka 7)¶

1. Malovu apinki motsutsana ndi Kutuluka Magazi Kowona: Malovu owala a pinki kwa maola 24 mpaka 48 ndi abwinobwino. Kutuluka magazi kwenikweni kumatanthauza kuti magazi ofiira akuphatikizana ndikudzaza mkamwa patangotha ​​masekondi angapo apukuta socket.
2. Kodi Liver Clot (Currant-Jelly Clot) ndi chiyani? Nthawi zina chiwalo chachikulu, chakuda, chopindika, chofanana ndi odzola (chofanana ndi chiwindi chaiwisi, 1 mpaka 3 centimita m'lifupi) chimatuluka m'mphako ngati kapu ya bowa pamene magazi ofiira owala akupitirira kutuluka pansi pa m'mphepete mwake. Ichi ndi chiwombankhanga cha venous fibrin chosakwanira (chiwindi cha chiwindi) chomwe chimalephera kusindikiza ma capillaries apansi a mafupa.
3. Mmene mungasiye kukhetsa magazi pachiwindi chikaundana: Mochepekedwa pukutani tsinde la odzola lotuluka mpaka kufika pamlingo wa soketi pogwiritsa ntchito kachidutswa kakang'ono konyowa konyowa (osakumba mkati mwa fupa la fupa lokha), ndipo nthawi yomweyo ikani padilo lopindika, lonyowa, lonyowa kapena wonyowa, kuluma thumba la tiyi mosalekeza 30 mpaka 45 mphindi zonse **.
4. Chifukwa Chake Thumba la Tiyi Wakuda Limagwira Ntchito: Tiyi wamba wamba (Camellia sinensis, osati tiyi wa azitsamba) ali ndi tannic acid (tannins), yomwe imakhala ngati mankhwala oletsa kupha anthu m'deralo omwe amatsuka ma capillaries ndikufulumizitsa mapangidwe a pulagi.
5. **Ngati magazi amalowa m'miyendo yopyapyala pakadutsa mphindi ziwiri za 30-mphindi ** (kapena ngati wodwala atenga **warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, kapena aspirin **), bwererani kwa dokotala wa opaleshoni kapena chipatala ED nthawi yomweyo **local 2% lidocaine ndi 00: 10 infilt 01:10 ** chinkhupule cha gelatin choyamwa (Gelfoam) kapena cellulose yopangidwanso ndi okosijeni (Opaleshoni) yonyamula **, ** ma sutures asanu ndi atatu **, ndi ** 5% tranexamic acid (TXA) compression yopyapyala **.

2. Sharp Bone Spicules (Alveolar Bone Sequestra) Kulowetsa Mkamwa (Masabata 1 mpaka 6)¶

Pakati pa masabata 1 mpaka 6 pambuyo pochotsa dzino, odwala nthawi zambiri amamva **ting'onoting'ono, lezala-lakuthwa, m'mphepete mwachingwe choyera ndikutuluka m'mphepete mwa chingamu chochiritsa ** (nthawi zambiri m'mbali mwa lilime lamkati la m'munsi mwa molar socket) yomwe imakanda lilime. Pazaka zopitilira 95%, izi ndi osati muzu wa dzino ; Ndi kagawo kakang'ono kakang'ono kakang'ono kakang'ono kakang'ono kakang'ono kakang'ono ** ka socket socket bone (bony spicule kapena sequestrum) kamene kamakankhidwira kunja ndi minofu yochiritsa. Phimbani pokuthwapo ndi ** orthodontic sera ngati ikutikita lilime lanu, kapena mulole dotolo wanu atulutse fupa lomwe latuluka mumasekondi 30 pansi pa gel osakaniza.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 nthawi yomweyo ngati mutachotsa kutupa kwakuya kwa khosi, kukweza pansi pakamwa, kuvuta kumeza, kapena kupuma. Kuti mumve zowawa zowuma kapena zowawa zapambuyo pochotsa, funsani dokotala wanu wapakamwa maola 24 pa foni kapena tsatirani American Association of Oral and Maxillofacial Surgeons (AAOMS) ndi ADA malangizo opangira socket kuvala muofesi (Alveogyl / ZOE) ndi multimocetaminoaminopheid NSAID.
• United Kingdom: Imbani 999 paulendo wapamtunda kapena kufalikira kwadzidzidzi kutupa kwa khosi. Patsiku lachitatu mpaka 5 lopweteka kwambiri pazitsulo zowuma kapena kutuluka magazi pambuyo pochotsa, funsani dokotala wa mano omwe adawachotsa kapena imbani NHS 111 kuti mupeze chithandizo chachangu cha tsiku lomwelo. Tsatirani NICE / SDCEP (Scottish Dental Clinical Effectiveness Programme) malangizo: socket youma (alveolar osteitis) imathandizidwa ndi 0.9% yothirira ndi mchere wothirira ndi Alveogyl kuvala movutikira kuphatikiza paracetamol ndi ibuprofen, osagwiritsa ntchito mankhwala opha mabakiteriya pokhapokha ngati kufalitsa matenda a bakiteriya kapena kutentha thupi.
• European Union: Imbani 112 pakagwa mwadzidzidzi matenda a m'khosi, kapena funsani a Emergency Dental Service kuti muvale socket dressing ya Alveogyl tsiku lomwelo.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand pazadzidzidzi zaulendo wa pandege. Tsatirani Malangizo Ochizira: Oral and Dental (Australia): kuthirira zitsulo zouma pang'onopang'ono ndi saline wotentha wosabala, ikani chovala chapafupi, ndikusunga maantibayotiki (phenoxymethylpenicillin kapena amoxicillin + metronidazole) kuti afalitse matenda odontogenic ndi zizindikiro za systemic.
• India, Japan, South Korea, ndi Asia-Pacific: Imbani 112 / 108 ku India, 119 ku Japan ndi South Korea, 995 ku Singapore, kapena 999 ku Malaysia ndi Hong Kong chifukwa cha matenda ozama m'mlengalenga, kapena pitani kuchipatala cha Oral ndi Maxillofacial Surgery cha ovulala ovala zinc-oxide eugen.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi ndingadziwe bwanji kusiyana pakati pa Dry Socket ndi matenda owopsa a bakiteriya omwe atulutsidwa pambuyo pochotsa?¶

Onani zinthu zitatu: tsiku lomaliza, kutupa kwakunja, ndi kutentha thupi. Dry socket (alveolar osteitis) imagunda pakati pa Tsiku la 3 ndi Tsiku la 5 mutatha kuchotsa dzino, kuchititsa ululu wopweteka wa 10/10 womwe umalowa m'makutu anu ndi kachisi, fungo loipa, ndi thumba lopanda kanthu lokhala ndi fupa loyera-loyera, koma silimayambitsa kutentha kwakukulu, mphuno yachikasu, mphuno, kapena mafinya. Matenda a bakiteriya enieni amayambitsa kutupa kwatsopano kapena kuipiraipira kumaso kapena pansi pa chibwano pambuyo pa Tsiku 3, kutentha thupi, kuzizira, mafinya amadzimadzi otuluka m'mafinya otupa ofiira, komanso kutsekeka kwa chibwano (trismus) kapena kulephera kumeza.

Chifukwa chiyani ndimawona zinthu zoyera kapena zachikasu mkati mwa dzenje langa pa Tsiku 3: ndi mafinya kapena socket youma?¶

Ngati muyang'ana mkati mwa socket yanu yochizira pa Tsiku 2 mpaka Tsiku 6 ndikuwona wosanjikiza wofewa, wonyezimira-woyera kapena wachikasu-wotuwa womwe ukuphimba dzenjelo pomwe ululu wanu ukukulirakulira ndipo mulibe malungo, musachite mantha ndipo musatulutse. Choyera chofewacho ndi fibrin yathanzi komanso minofu ya granulation, makamaka nkhanambo yonyowa yomwe imapangika mkati mwa malovu amkamwa mwako utoto wofiyira ukatuluka m'magazi. Ndizosiyana ndendende ndi socket youma ndipo ziyenera kusiyidwa mosadodometsedwa.

Chifukwa chiyani kugwiritsa ntchito syringe ya pulasitiki yokhotakhota yothirira dotolo wanga wapakamwa kunandipangitsa kuti ndikhale ndi socket youma?¶

Madokotala ochita opaleshoni pakamwa nthawi zambiri amatumiza odwala kunyumba ndi syringe ya pulasitiki yopindika (syringe ya Monoject) kuti akatulutse chakudya chotsekeka kuchokera m'mabowo a mano ochepa, koma odwala nthawi zambiri amalakwitsa kugwiritsa ntchito pa Tsiku 1, Tsiku la 2, kapena Tsiku la 3. M'masiku oyambirira a 5 pambuyo pa opaleshoni, magazi omwe ali mkati mwa nsagwada amakhala osalimba; Kuthamangitsa jeti yamadzi muzitsulo tsiku la 5 mpaka 7 lisanafike kuphulika kwa magazi kuchokera m'fupa ndipo kumayambitsa socket yowuma mwamsanga. M'masiku 2 mpaka 5, ingopendekerani mutu wanu pang'onopang'ono ndi madzi amchere ofunda ndikuulola kuti ugwere mu sinki osalavula; dikirani mpaka Tsiku 5 mpaka 7 (kapena tsiku lenileni la dokotala wanu) musanagwiritse ntchito syringe.

Kodi kumwa maantibayotiki otsala kuchiritsa socket youma?¶

Ayi. Mayesero achipatala ndi malangizo ovomerezeka a mano padziko lonse lapansi (kuphatikizapo ADA, AAOMS, ndi UK NICE / SDCEP) amatsindika kuti socket youma si matenda a bakiteriya; ndi kusungunuka kwa mankhwala a magazi (fibrinolysis) omwe amasiya mafupa opanda kanthu ndi mathero a mitsempha ya trigeminal poyera mpweya ndi malovu. Maantibayotiki amkamwa sangasiye kuwawa kowuma. Chithandizo chofulumira kwambiri, chothandiza kwambiri ndikuyenda kwa mphindi zisanu kwa dokotala wamano kapena dotolo wapakamwa kuti muchotse zinyalala zazakudya zomwe zatsekeredwa ndikuyika phala la eugenol medicated (monga Alveogyl) mwachindunji pafupa lopanda kanthu, lophatikizidwa ndi ibuprofen yapakamwa ndi acetaminophen.

Chifukwa chiyani tsinde louma la mano limapangitsa khutu langa, kachisi, ndi diso kuti zipweteke kwambiri?¶

Mano apansi ndi nsagwada zimaperekedwa ndi mitsempha yotsika ya alveolar, yomwe ndi nthambi ya magawano a mandibular a trigeminal nerve (Cranial Nerve V3). Pamene fupa lopanda kanthu mkati mwa tsinde la mano limakhala lotupa ndi kutulutsa mankhwala opweteka a bradykinin, chizindikiro cha kuvutika chimayenda mpaka thunthu la mitsempha ya mandibular, thunthu lomwelo la mitsempha lomwe limapereka mitsempha ya auriculotemporal yomwe imakupatsirani ngalande ya khutu, eardrum, ndi kachisi. Chifukwa nthambi zonse ziwiri zimagawana njira yapakatikati ya minyewa, ubongo wanu umatanthauzira kupweteka kwa nsagwada komwe kumawonekera ngati kupweteka kwa khutu ndi mutu wapakachisi kumbali imeneyo.

Kodi kuluma thumba la tiyi lakuda kumathandizira bwanji kusiya magazi pambuyo pochotsa dzino?¶

Masamba a tiyi wakuda (Camellia sinensis, osati peppermint kapena chamomile) amakhala ndi tannic acid (tannins). Mukatsika kapena kunyowetsa thumba la tiyi wakuda m'madzi ofunda, finyani dontho lochulukirapo, ndikuluma molunjika pazitsulo zotuluka pamano kwa mphindi 30 mosalekeza, kuthamanga kwa makina kumakakamira ma capillaries pomwe tannic acid imapangitsa mitsempha ya m'magazi ndikuthandiza mapulateleti ndi fibrin kuwunda mwachangu.

Magwero ndi malangizo ovomerezeka¶

• American Association of Oral and Maxillofacial Surgeons (AAOMS) ndi American Dental Association (ADA, United States): Clinical Practice Guidelines on Third Molar Surgery, Alveolar Osteitis (Dry Socket) Prevention and Management, and Post-Operative Odontogenic Infections.
• Scottish Dental Clinical Effectiveness Programme (SDCEP) ndi National Institute for Health and Care Excellence (NICE, United Kingdom): *Kusamalira Mavuto Aakulu A Zamano: Alveolar Osteitis (Dry Socket) vs. Spreading Post-Extraction Infection Triage *.
• Cochrane Oral Health Group: Local Interventions for the Management of Alveolar Osteitis (Dry Socket) (Daly et al., Cochrane Database of Systematic Reviews, chlorhexidine prophylaxis ndi Alveogyl / eugenol obtundent dressings).
• Malangizo Ochizira: Oral and Dental (Australia): Zovuta Pambuyo Pochotsa: Alveolar Osteitis, Second Hemorrhage, ndi Odontogenic Deep Space Infections.
• World Workshop on Oral Medicine ndi International Association of Oral and Maxillofacial Surgeons (IAOMS): Pathophysiology of Fibrinolytic Alveolitis (Birn's Hypothesis) ndi Trigeminal Referred Otalgia.

Maupangiri ogwirizana¶

• Ludwig angina, chiphuphu cha mano, ndi kutupa kwa submandibular airway
• Korona wamano wotayika, mlatho wotayirira, kapena wosweka wodzaza thandizo loyamba
• Matenda adzidzidzi a mano, kutukusira kwa dzino lotuluka, ndi kupweteka kwa dzino
• Sepsis ndi kuzindikira kugwedezeka kwa septic ndikuyesa mwadzidzidzi
• Nambala zadzidzidzi malinga ndi dziko