Daanka Go'ay, Afka Furan, iyo Daryeelka Jidka Hawada Sare ee Jabka daran¶

Haddii daanka hoose ee qofku uu si weyn u furmo ka dib hamaansi weyn ama booqasho ilkeed (Acute Temporomandibular Joint [TMJ] Dislocation), ama daanka hoose iyo wejigooda dhexe ay ku burburaan shil baabuur, weerar, ama dhicid (* waa ** xannibaad ba'an oo marin-haweedka sare ah . Sababtoo ah carrabka bini'aadamka wuxuu si toos ah ugu xiran yahay daanka hore ee gudaha daanka hoose ( mandibular symphysis*), jabka labada dhinac ee garka ayaa u oggolaanaya dhammaan fardaha kabaha fardaha ee lafta iyo carrabka inay si toos ah gadaal ugu dhacaan dhabarka cunaha marka dhibbanaha loo dhigo dhabarka (glossoptosis). Waxaa taa ka sii daran, daanka sare ee jaban (Le Fort fractures) waxay jeexjeexaan laamaha halbowlaha maxillary ee gudaha, daadinta dhiigga, xinjirowga dhiigga, iyo ilka-goynta hoos ugu dhacaya hawo-mareenka hawada haddii bukaanku ku xiran yahay sariirta dhabarka. Haddii qof ka dhaawacmay wejiga ama daanka uu leeyahay neefsasho sanqadh ah ama khuuraya, dhiigbax culus oo ka imanaya afka iyo sanka, ama daanka oo furan, wac lambarka degdegga ah ee degaankaaga isla markiiba nambarada degdega ah. Dib u eeg daryeelka dhaawaca ee la xidhiidha xaaladaha degdegga ah ee ilkaha iyo ilkaha la garaacay, dhaawacyo madaxa iyo miyir beelkaiyo dhaawacyada laf dhabarta iyo dhaqdhaqaaq la'aanta.

Hadda samee tan¶

1. **Haku qasbin bukaan miyir qaba oo ka jaban daanka hoose ama dhexda dhexe inuu dhabarka u seexdo.
2. ** Haddii bukaanku miyir daboolan yahay ama u baahan yahay dhaqdhaqaaq la'aanta laf dhabarta, ku rid booska ka soo kabashada dhaawaca dambe (gal-rog-rogid dhinacooda iyada oo la adeegsanayo xasilinta qoorta gacanta) ama u jiid carrabkooda iyo daanka hoose isla markiiba.
3. Wac lambarkaaga degdega ah isla markaaba** (911 gudaha Maraykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Ingiriiska) wixii dhaawac wajiga ah oo tamar sare leh, jabka daanka, ama daanka go'ay oo aan xidhmi karin.
4. **Isla markiiba u fiiri afka gudaha oo ka soo saar xinjiro dhiig oo dabacsan, ilko soo baxay, ilko jabay, ama matag adoo isticmaalaya far galoofaysan ama nuugista. Ku badbaadi caanaha qabow ama cusbada ilkaha joogtada ah ee soo baxay (eeg xaaladaha degdegga ah ee ilkaha).
5. ** Haddii bukaan daamankiisu xidhan yihiin (Maxillomandibular Fixation [MMF]) ama lagu xidho dhejisyo adag ka dib qalitaanka daanka uu bilaabo matag ama xiiqsi:**
6. Si toosan u fadhiiso oo madaxa hore u tii isla markiiba si ay matag dareere ahi uga baxsadaan daldaloolada ka dambeeya ilkahooda gadaasha iyo sanka.
7. Kaliya haddii aysan nadiifin karin marin-haweedkooda, ay buluug isu beddelayaan, ama ay miyir beelayaan:** Isticmaal ** silig-gooyayaasha degdegga ah ama xiirashada dhaawacyada culus** (taas oo ay tahay in lagu dhejiyo sariirta isbitaalka bukaanka ama lagu qaado jeebka shaadhka mar kasta) si aad u dhuuqdo ** fiilooyinka dhexdhexaadka ah ee tooska ah ama xirmooyinka caagga ah ee soconaya waqti yar ee u dhexeeya UP-AND*- in la gooyo fiilooyinka jiifka ah ee ku duudduuban ilkaha laftooda).
8. Xanuun la'aan ama xanuun "daanka furan" ka dib hamaansiga, qosolka, ama matagga (Acute Anterior TMJ Dislocation with eber trauma): Ku taageer gunta hoose ee daanka hoose gacmahaaga ama dharbaaxada shukumaan jilicsan, mari cadaadi diirran oo ku dul cadaadi murqaha dhabannada ee dhegaha hortooda si aad u yarayso murqaha gadhka ama gadhka, Luqunta kondhilarka), oo u tag Waaxda Gurmadka si tartiib ah Syringe-Roll ama Dhimista laba-geesoodka ah.
9. ** Iska hubi kabuubyada faruuryaha hoose iyo gadhka, oo hubi in ilkaha danbe ay si caadi ah u kulmaan iyo in kale waxay caddaynaysaa in maansadii jabtay.

Geedka go'aanka: Maareynta marin-haweedka iyo kala soocida kala-soocidda daanka kala-baxa iyo jabka wejiga¶

flowchart TD
    Start["Daanka Ba'an / Dhaawaca Wejiga AMA Awood la'aan degdeg ah in la xidho afka ('Daanka- Furan')"] --> AirwayFirst{"TALLAABADA 1: Hubi Dareenka Hawada & Farsamada: Ma jiraan dhaawac tamar sare leh, dhiig-bax afka ah/sanka oo culus, gurguuran, ama daanka hoose oo aan degganayn?"}

    AirwayFirst -->|"HAA: Dhaawac daran oo waji ah, Dhiig-baxa, ama Stridor/Gurgling"| PositionAirway["1. Wac 911/112/999 Isla markiiba. 2. Haddaad toosto: U fadhiiso si toos ah oo hore u tiirsan si aad dhiigga u daadiso oo carrabka hore ugu sii hayso. 3. Hadday miyir la'dahay: Geli-ku gal SIDE (Meesha Dhaawaca Dambe) oo leh kontoroolka C-lafdhabarta ee gudaha + carrabka / gadhka hore u jiid. 4. Tuubooyinka sanka ee ZERO."]

    PositionAirway --> FractureType{"Aqoonso Qaabka Jajabka Khatarta Sare ee Gaarka ah"}

    FractureType -->|"Daanka Hoose Oo Dabcsan Labada Dhinac + Carrabka Oo Dib U Soo Dhacaya + Burburka Sagxada-Afka"| FlailMandible["MANDIBULAR BILATERAL ('FLAIL / BAADI-GACANTO') JABAN: U soo jiid qaybta hore ee garka/carrabka gacanta ama duubka shukumaanka/ tolitaanka; U diyaari soo jeed degdeg ah ama marin-haweedka qaliinka (cricothyrotomy)."]

    FractureType -->|"Daanka Sare / Wajiga Dhexe ee Mobilka Marka uu jiidayo Ilkaha hore ee Sare + Dhiig-cunaha Sanka"| LeFortPath["LE FORT I, II, AMA III JABAN DHEXE: Mid toosan/dhinac; Xirmooyinka buufinta sanka ee hore/ danbe + hoos u dhigista palatal-ka gacanta haddii dhiigbaxa halbowlaha maxillary gudaha; ka hubi CSF rhinorrhea."]

    AirwayFirst -->|"Ma jiro dhaawac ama xooga ugu yar (Hamaansi, qosol, Imtixaan Ilkaha, Matag, ama Dawooyinka Ka-hortagga Dhimirka): Afka ayaa si weyn u furan"| TMJCheck{"TALLAABADA 2: Qiimee 'Af- Furan' Aan Argagixiso ahayn: Labada Dhinacba Ma Isku Siman yihiin Mise Gadhku Hal Dhinac Ayaa Loo Bedelay?"}

    TMJCheck -->|"Afka Quful Xarun Furan Oo Balaadhan (Labada Dhinac) AMA Gadhka U Leexsan Dhinaca Ka Soo Horjeeda"| AnteriorTMJ["Kala-baxa Xun ee TMJ: 1. Ka hubi Dystonia Ba'an ee Daroogadu keentay (haloperidol, metoclopramide -> sii IV diphenhydramine / benztropine). 2. U tag Waaxda Gurmadka Siringe-Roll ('Gacan-free') ama Dhimista Hippocratic labada dhinac."]

    TMJCheck -->|"Taariikhda Feer/Diitaan + Ilkaha Ma Safraan (Malocclusion) + Kabuubyo Bishimaha Hoose + Hematoma Sagxada-Afka"| SimpleMandible["JABAN MANDIBULAR AMA KONDYLAR: 1. Ha isku dayin dhimista TMJ ka hor CT/Panorex Raajada. 2. Fashilmay 'Tijaabada Qaniinyada Blade'; waxay u baahan tahay Waaxda Degdegga ah CT, antibiyootiga IV (jabka furan ee godka iligga), & hagaajinta maxillofacial."]

Xaalada 1: Ba'an Temporomandibular Joint (TMJ) Kala-bax ("Daanka- Furan")¶

Anatomy: Sida kondylaha mandibular uu ugu hor xayiran yahay sumcadda articular horteeda¶

** Isku-dhafka ku-meel-gaadhka ah (TMJ) *** waa isku-xidhka isku-xidhka-iyo-boodboodka halkaas oo kubbadda wareegsan ee dhabarka sare ee lafta hoose ee daanka (** kondylaha mandibular ) waxay ku fadhidaa gudaha godad gacmeed oo salka hoose ee dhafoorka horteeda kanaalka dhegta ( fossa glenoid**). Si toos ah bareesadaas horteeda waxa u fadhiisa buur lafo siman oo la yidhaa heernimada lafta ku meel gaadhka ah: 1. Furitaanka Afka Caadiga ah: Markaad wax yar furto afkaaga, kondhilehu waxa uu u rogmanayaa sida hindhis gudaha godkiisa. Marka aad si ballaaran u furto si aad u hamaansato ama u qaniinto sandwich qaro weyn, ** muruqa pterygoid-ka dambe** waxa uu hore u soo jiidayaa kondhile-ka dhanka dabada dambe ee sumcadda articular, wuxuuna dib ugu soo noqdaa godkiisa marka aad afkaaga xidho. 2. ** Kala-baxa hore ee TMJ (95% of TMJ Dislocations):** Inta lagu jiro furitaanka afka balaadhsan, sida ** hamaansi qoto dheer, qosol qaylo leh, soo saarid ilkeed oo dheer, matag, suuxdin, ama laryngoscopy *, kondylaha mandibular ayaa simbiriirixan ** aad u fog, isaga oo si buuxda uga boodaya meesha ugu sarreysa ee fanka. 3. Waa maxay sababta daanka uusan iskiis ugu xiri karin (The Masseter Spasm Trap): Isla markiiba kondyle-ku uu ku siibto meesha ugu sarreysa ee murqaha murqaha, murqaha xirmidda daanka ( masseter, temporalis, iyo medial pterygoid ***) waxay galaan xanuujin ka hortag ah. Halkii ay daanka dib ugu soo celin lahaayeen godka, murqahaas xiiqsan waxay soo jiidaan kondylaha ** si toos ah kor ugu kacaya meesha ugu sarraysa ee murtida articular **, iyagoo si farsamaysan u xiraya daanka si ballaaran.

Laba-geesoodka ah vs. Kala-baxa Hore ee Hore ee Midaysan (Calaamadaha Muuqaal)¶

• ** Kala-baxa hore ee TMJ ee laba geesoodka ah (Inta badan):** Kondyowga bidix iyo midig labaduba waxay horay uga boodaan saldhigyadooda. Afka waxa loo quful si siman u fur furan (\(3\text{ to }5\text{ sentimeter}\) inta u dhaxaysa ilkaha hore), daanka hoose ayaa horay u soo baxay (** muuqaalka prognathic **), qofku candhuuf buu u daadiyaa, wuxuu ku hadlaa hadal af-duuban, wuxuuna leeyahay ** god godan oo toos ah oo ku yaal labada dhegood ee tragi ***.
• ** Kala-baxa Hore ee TMJ ee Midaysan:** Hal kondyle ayaa horay uga soo booday godkeeda. Afku wuu furan yahay, ** iyo garka si muuqata ayaa loo wareejiyay dhinaca ka soo horjeeda (caafimaadka)**.
• ** Is barbar dhig jabka Qoorta Condylar:**
  • ** Kala-bax TMJ midaysan:** Gadhku way ka leexataa Dhinaca dhaawacan (dhinaca caafimaadka qaba), afkuna wuu xidhan yahay furan.
  • Jajabka Mandibular-ka Midaysan: Garku wuu leexdaa Xagga dhaawaca (jaray) marka afka la furayo.

Had iyo jeer meesha ka saar Daroogada ay keentay Oromandibular Dystonia (The Great TMJ Mimic)¶

Kahor intaadan u qaadan in daanka furan ama qalloocan uu yahay mid farsamaysan oo keliya, weydii: "Bukaanku ma qaatay daawada lalabo, dawooyinka dhimirka, ama daroogada waddooyinka 24 ilaa 72 saacadood ee la soo dhaafay?" - Daawooyinka xannibaya dopamine D2 reseptors, gaar ahaan ** metoclopramide (Reglan), prochlorperazine (Compazine), promethazine (Phenergan), haloperidol (Haldol), risperidone, olanzapine, ama aripiprazole , waxay kicin karaan ** fal-celin dystonic ah oo dheeri ah (oromandibular. - Maxaa dhacaya: Foosha teetanic ee aan ikhtiyaarka lahayn ee xuubka lateral, carrabka, iyo muruqyada qoorta ayaa jiidaya daanka si ballaaran ama dhinac (badanaa kala-baxa TMJ-da labaad), oo ay weheliso soo-bandhigidda carrabka ama kor u qaadista indhaha ( xiisadda oculogyric**). - Daawaynta Degdegga ah: Maaraynta ** Diphenhydramine xididka ama muruqa ah (\(25\text{ to }50\text{mg}\)) ama Benztropine (\(1\text{ to }2\text{ mg}\) IV/IM)

Farsamooyinka Yaraynta Cisbitaalka ee Kala-baxa Hore ee TMJ¶

• (Xeerka Gargaarka Koowaad: Waligaa ha ku dhufan, dharbaaxin, hana u daacin dhinaca hore ee garka go'ay, kaas oo jabin kara qoorta kondhilarka

• ** Farsamada Xaraashka-Roll "Gacmaha- Xorta ah" ee aan duullaanka ahayn (Qaabka casriga ah ee ugu dhaqsaha badan uguna xanuunka yar, 95%+ heerka guusha):**

• Looma baahna suuxdin faleebo ah iyo suul dhaqtar oo afka ku jira looma baahna.
• Takhtarku wuxuu dhigeyaa caag ** 5-millitir ama 10-mililiitar foosto caafimaad** si toos ah inta u dhexeysa bukaanka Ilkaha sare iyo hoose ee dhabarka dhinaca kala go'ay.
• Bukaanku si tartiib ah ayuu u qaniina foostada saliingaha oo siringaha hore iyo gadaal ugu rogaya ilkahooda dambe dhexdooda sida biin duuban.
• **Sida Ay U Shaqeyso
• Farsamada ka baxsan: Dhinac, dhakhtarku waxa uu dib u soo jiidayaa habka coronoid-ka ee dhanka dhabanka isaga oo si tartiib ah dib ugu riixaya kondyowga lidka ku ah, isaga oo iska ilaalinaya in faraha afka la geliyo.
• ** Hoos-u-dhimista Caadiga ah ee Intraoral Bimanual (Hippocratic) (oo leh TMJ Lidocaine Block ama Suuxdin):**
• Dhaqtarku waxa uu ku duubaa labada suul ee faashad qaro weyn, waxa uu si adag ugu xidhaa bukaanka madaxa fadhiyey gidaar, labada suulna waxa uu saarayaa ** cirifka dhabarka hoose ee calamiga ah (jidhka dibadda ah) ** DIB U NOQODAY ***.
• Daryeelka Dhimista Kadib: Marso duub duub madaxa gadhka jilicsan, raac cunto jilicsan oo aan calalinayn 7 ilaa 10 maalmood, iyo ** had iyo jeer feedh gadhka hoostiisa mar kasta oo hamaansigu** si aanu afku u furmi karin wax ka badan 2 sentimitir.

(Xusuusin ku saabsan Naadirta Sare iyo Dib-u-baxyada TMJ ee Dambe: Haddii dhabarjab tamar sare leh ay ku dhufato garka, kondhilaha ayaa loo kaxeyn karaa ** kor u kaca ilaa xudunta dhexe ee cranial fossa [Superior Dislocation]* ama ** BACKWARD gudaha kanaalka dhegta [Dib-u-baxa, taasoo keenta dhiig-bax dhegta ah oo xiran]**. CT-ga degdega ah)*

Xaaladda 2: Jajabka Mandibular iyo Daanka Wax-ka-qabashada ah¶

Waa maxay sababta Mandible-ku u jebiyo laba meelood hal mar (Xeerka "lafaha giraanta")¶

Daanka hoose (** mandible**) waa qaanso lafo adag oo U-qaab ah oo ku dheggan dhakada labada daraf ee kala goysyada ku meel gaarka ah, samaynta giraan biomechanical ah oo xiran: - Xeerka giraanta kiliinikada: Sida pretzel adag ama miskaha lafaha, ** ugu dhawaan inaadan waligaa jebin giraanta lafta adag hal meel oo kaliya**. In ka badan ** 50 boqolkiiba dhammaan jabka mandibularku waa laba geesood ama badan** (tusaale ahaan, feerka midig ee daanka ayaa sababa jabka mandibular jirka/parasymphysis si toos ah hoosta feedhaha IYO jabka labaad ee jabinta xagasha mandibular-ka bidix ama luqunta hoose ee bidix** dhinaca ka soo horjeeda). - Mar kasta oo hal jab laga helo mandible, dhakhaatiirtu waa inay ugaadhsadaan jabka labaad ee dhinaca ka soo horjeeda.

Sidee Jab laba geesood ah ee Mandibularku u keeno Neefta ("The Flail Mandible")¶

Muruqyada ugu weyn ee carrabka bini'aadamka (** muruqa genioglossus , kaas oo u jiidaya carrabka si uu u furo marin-haweedka pharyngeal) wuxuu si toos ah ugu dhejiyaa laba laf dhabarta lafaha yaryar ( tubercles genial ) oo ku yaal dusha dambe ee gudaha ee lafta garka hore ( mandibular symphysis ): - Haddii weerar, raad isteerin, rasaas, ama dhicidu jebiyo daanka hoose ee ** labada dhinac bidix iyo midig ee gadhka *** (a ** parasymphyseal laba geesood ah ama jidhka laba geesood ah "baaldi-handle" jabka ), jajabka gadhka dhexe ee uu carrabku ku dheggan yahay hadda gebi ahaanba waa ka go'an yahay madaxa intiisa kale. - Maxaa dhacaya marka uu bukaanku si siman u jiifsado dhabarka: Isla markiiba dhakhaatiirta caafimaadka ama kuwa ag jooga waxay jiifiyaan bukaan dhabarka ka jaban mandibular laba geesood ah, cuf-jiid iyo hoos u soo jiidashada muruqyada mylohyoid iyo geniohyoid oo kala gooyay lafta gadhka dhexe iyo dhammaan saldhigga carrabka ** si toos ah u xiran gidaarka dambe. ( Glossoptosis farsamaysan oo degdeg ah). - ** Samatabbixin naf-badbaadin degdeg ah: 1. Fadhii bukaanka miyir qaba oo toosan oo hore u tiirsanaya sidaa awgeed cufisjiidku waxa uu ka soo jiidaa qaybta gadhka iyo carrabka hore uga soo baxa dhuunta. 2. Bukaanka miyir daboolan ama miyir daboolan: ** Ha isku hallaynina madax-jaridda caadiga ah (taas oo aan waxba qabanayn marka garku ka go'o madaxa). Si toos ah ugu qabso ** ilkaha hoose ee hore iyo jajabka lafta gadhka gacan-gacan (ama faashad ku duub carrabka laftiisa)** iyo **jiid qaybta gadhka dhexe ee jabay iyo carrabka si toos ah HOR (hore) xagga saqafka ***. Gacanka dib u soo kicinta, dhakhaatiirta qalliinka dhaawacyada ayaa ka gudbiya tolmo xariir oo qaro weyn ama fiilada shukumaanka ah iyagoo sii maraya carrabka dhexe ama agagaarka symphysis si ay horay ugu sii hayaan ilaa marin-haweedka la geliyo ama qalliin cricothyrotomy ah ayaa la sameeyaa.

Calaamadaha Sariirta ee Jajabka Mandibular (iyo "Tijaabada Qaniinyada Caqliga")¶

Ka hubi bukaan kasta oo qaba dhaawaca wejiga Shanta Calaamadood ee Caadiga ah ee Daanka Hoose ee Jabsan: 1. Malocclusion Subjective (Calamadaha ugu xasaasisan): Si tartiib ah u weydii bukaanka: "Markaad si fudud isu keentid, qaniinyadaadu ma dareemaysaa wax caadi ah, mise ilka qaar baa goor hore ku dhuftey?" Haddii bukaanku yiraahdo qaniinyadooda waxay dareemayaan "off," daanka ayaa jabay ilaa uu si kale u caddeeyo CT. 2. Hematoma Sublingual (Calaamadda Baahiyaha): Weydii bukaanka inuu caaradda carrabkiisa u qaado xagga saqafka afkooda oo uu eego dabaqadda afka ee carrabka hoostiisa. Madow madow ama guduudan ** nabarro (ecchymosis) ama hematoma kor u kaca ee sagxada afka** waa ku dhawaad ​​100 boqolkiiba ogaanshaha jir mandibular hoose ah ama jabka asymphyseal. 3. ** Kabuubyo Bishimaha Hoose iyo Garka (Alveolar Inferior / Neerve Anesthesia):** Dareemaha alveolar-ka hoose wuxuu dhex maraa tunnel-ka lafaha bannaan ee dhexda u mara bartamaha lafta hoose ka hor inta uusan ka bixin gadhka. Jab xagga xagasha, jirka, ama parasymphysis ayaa fidisa ama kala goysa neerfahaan, taasoo ka dhigeysa kala bar bushimaha hoose iyo garka inay kabuubmaan. 4. Tallaabada Ciridka iyo Dhiigbaxa u dhexeeya Ilkaha: Farqiga jaranjarada iyo jeexjeexa muuqda ee cirridka inta u dhaxaysa labada ilkood ee hoose. *(Xeerka Caabuqa ee Muhiimka ah: Sababtoo ah booska seedaha periodontal ee ku wareegsan ilig kasta wuxuu si toos ah ula xiriiraa lafta daanka ee hoose, JABAD KASTA oo mandibular ah oo soo mara qaybta ilka-xannuunka) caafimaad ahaan waa JABAN FURAN (COMPOUND) 5. ** Tijaabada Qaniinyada Carrabka (95% Qiimaha Saadaasha Xun ee Daraasaadka Kiliinikada): Haddii bukaanku leeyahay daan xanuun khafiif ah iyo ilko u eg, takhtar degdeg ah wuxuu dhigayaa carrabka niyad-jabka ah ee alwaax meel u dhexeysa gowsaha bidix, wuxuu bukaanka weydiistaa inuu si adag u qaniina, oo uu leexiyo daab alwaax ah. Haddii uu bukaanku si adag u qaniino labada dhinac ee bidix iyo midig in takhtarku uu kala badh ka dhigi karo daabka carrabka alwaax isagoo maroojin kara, jabka mandibular ee muhiimka ah ee rugaha caafimaadka ayaa meesha laga saaray iyadoo la hubo \(>95\%\).

Xaaladda 3: Le Fort I, II, iyo III Jabka wejiga dhexe¶

Isku dhacyada baabuurta xawaaraha sare leh, shilalka mootooyinka, saamaynta warshadaha, ama dhicis daran, xoog ba'an oo garaaca bartamaha wejiga waxay jebisaa **maxilla (daanka sare), lafaha sanka, orbits, iyo taarikada pterygoid ee lafta sphenoid ** oo ay weheliyaan saddex qaab-dhismeed daciif ah oo heer sare ah oo uu qeexay dhakhtar Faransiis ah René Le Fort.

Master isbarbardhigga kiliinikada ee Le Fort I, II, iyo III jabka¶

Xakamaynta Degdegga ah ee Dhiig-baxa Torrential Maxillofacial iyo Aqoonsiga Liidashada CSF¶

1. **Waa maxay sababta Le Fort Fractures uu si xoog leh u dhiigo Marka jabka Le Fort II ama III uu jebiyo maxilla dambe, dhiig ayaa isku mar ka soo daadanaya labada dulalka sanka iyo si toos ah xagga dambe ee cunaha, si degdeg ah u buuxinaya caloosha iyo marin-haweedka.
2. Xakamaynta Dhiigbaxa Cisbitaalka Kahor/ ER: Fariiso bukaanka si toos ah oo hore u tiirsan haddi aad soo jeeddo, ama booska soo kabashada danbe haddi suuxsan tahay. Marka tuubada endotracheal ee afka ama cricothyrotomy qalliin ay xaqiijiso marin-haweedka, takhaatiirta deg-degga ah waxay geliyaan ** laba-balloon dhabarka dambe / hore ee sanka kateetarka (ama tuubbada Foley) , si adag ugu xidh daloolka afka iyo pharynx si adag oo faashad ka soo horjeeda mandilaha xasilan, oo kor u qaadaya lafaha jajabku waxay yareeyaan jeexjeexa halbowlayaasha) iyagoo hawlgelinaya shucaaca dhexdhexaadka ah ee ** embolization arterial transcatheter **.
3. Sida loo Aqoonsado Dareeraha Maskaxda (CSF) ee Dhiiga Sanka ku Dhashay:
4. Jabka Le Fort II ama III, biyo nadiif ah ** dareere cerebrospinal ** ka soo daadanaya xuub dural jeexan oo ku yaal saqafka saqafka sare ee sanku wuxuu ku daraa dhiig.
5. Calaamadaha: Bukaanku waxa uu dareemaa dareere biyo leh oo bir ah ama milix leh** oo ku socda dhabarka cunaha marka ay fadhiyaan, ama dareere saafi ah oo si degdeg ah sanka uga tifqaya marka uu hore u tiirinayo. Haddii dhibicda dheecaanka sanka ee dhiigga leh ay ku dhacdo barkin cad ama xaashida faashad, CSF-ga ka sii cad ayaa u guura dibadda si ka dhaqso badan unugyada dhiigga cas, samaynta giraan huruud ah oo casaan ah oo daciif ah oo ku wareegsan barta dhiigga dhexe (** calaamadda "Halo" ama "Double-Ring" *; lagu xaqiijiyay shaybaarka isbitaalka iyada oo la adeegsanayo ** Beta-2 Transferrin).
6. Xeerka Gargaarka Koowaad ee CSF Rhinorrhea: ** Waligaa sanka si adag ha ugu xirin guriga, waligaa sanka ha dumin, hana isku dayin inaad dabada sanka xirto si aad u joojiso dareeraha nadiifka ah ee ka soo daadanaya. pneumocephalus**). Si dabacsan ugu qabso dareere ka tifqaya suufka faashad nadiif ah oo sanka hoostiisa lagu hayo.

Xaalad Gaar ah: Daryeelka Degdegga ah ee Bukaannada Daanka Fiilada leh (Maxillomandibular Fixation)¶

Bukaannada ka soo kabanaya qalliinka mandibular ama Le Fort jabka waxay si joogta ah ugu soo laabtaan guriga 2 ilaa 6 toddobaad iyagoo wata bir ** baararka qaansada ** lagu xiray cirridkooda sare iyo hoose oo ay ku xiran yihiin fiilooyin bir ah oo toosan ama xargo caag ah oo culus (** Maxillomandibular Fixation [MMF]**).

Xeerka Matagga & Mergada ee Bukaannada Daanka-Xadhkaha leh¶

1. Sababta mataggu inta badan uma baahna in si toos ah loo gooyo: Matag dareere ah iyo aashitada caloosha waxay ka gudbi karaan godadka gadaashooda dhabarka dambe (** trigone retromolar ***), ilkaha dhexdooda, iyo daloollada sanka. Bukaan kasta oo daanka leh waa in guriga lagu qoraa afka ama kala diri kara ondansetron (Zofran) si looga hortago lallabbo ka hor inta uusan bilaaban.
2. Xeerka Wire-Cutter-ka ee Waajibka ah: Bukaan kasta oo leh hagaajinta siligga birta ah ee dhexdhexaadka ah waa inuu ku qaadaa ** gooyaa fiilooyinka qalliinka ee u go'ay (ama xiirid culus oo jug culus ah oo loogu talagalay xirmooyinka laastikada)** meel bannaan oo qoorta ah, jeebkooda, ama si muuqata loogu duubo madaxa sariirtooda 24 saacadood maalintii.
3. Meesha Laga Gooyo Marxaladda Degdegga ah ee Waddada Hawo-mareenka: Haddii bukaan-jiif-daanka ahi uu nuugo matag adag, oo aanu nadiifin karin marin-haweedkooda oo horay u sii foorarsanaya, isu rogaya cyanotic (buluug), ama uu miyir daboolmo:
4. Kala saar bushimaha sare iyo kuwa hoose si aad u soo bandhigto biraha birta ah ee ciridka.
5. ** Jar KALIYA fiilooyinka toosan (ama xargaha caagga ah) ee kor-iyo-hoos u socda inta u dhexeysa daanka sare iyo hoose** (caadiyan 2 ilaa 3 siddo oo dhanka bidix ah iyo 2 ilaa 3 siddo oo dhanka midig ah).
6. Ha isku dayin inaad gooyso fiilooyinka jiifka ah ee ku duudduuban saldhigga ilkihiisa, kuwaas oo aan xirin daanka. Marka wareegyada toosan la jaro, daanka hoose ayaa isla markiiba furma.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

• Mareykanka iyo Kanada: garaac 911. Sida hoos timaada ACS ATLS iyo AAOMS borotokoolka dhaawacyada, dhaawaca maxillofacial ee leh is-afgaradka marin-haweedka waxaa loo qaadaa si toos ah/horumarin (haddii la soo jeedo iyo c-lafdhabarta la nadiifiyo) ama meeleynta nuugista iyo meelaynta dambe ee Xarunta Dhaawaca oo u qalabaysan fiidiyoowga laryngoscopy iyo cricothyrotomy qalliin.
• United Kingdom: garaac 999 (ama 112). Raac ** Resuscitation Council UK ***, NICE Trauma Major (NG39), iyo BAOMS tilmaamaha xakamaynta dhiigbaxa maxillofacial, ka fogaanshaha marinnada hawadu ee sanka ee dhaawaca salka madaxa, iyo dhimista TMJ.
• Midowga Yurub: Wac 112. Raac ERC iyo EACMFS tilmaamaha marin-haweedka dhaawaca.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand. Raac nidaamka ANZCOR iyo ANZAOMS
• Hindiya iyo Aasiya-Pacific:** Wac 112 gudaha Hindiya, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 995 gudaha Singapore. Shilalka mootada oo leh mandibular isku jira iyo jab Le Fort, dhibbanaha u janjeero dhanka hore ama dhinacooda inta lagu jiro gaadiidka si dhiiga afka uu u soo baxo dibadda.

Eeg nambarada degdega ah dhamaan lambarada dirista degdega ah ee caalamiga ah.

Su'aalaha soo noqnoqda¶

Maxaa daankaygu u furay hamaansi weyn ka dib, maxaan u riixi waayay gadhka si aan u xidho?¶

Markaad afkaaga si aan caadi ahayn u kala qaaddo inta lagu jiro hamaansiga, qosolka, ama habka ilkuhu, kubbadda wadajirka ah ee wareegsan ee dhabarka daankaada hoose (** kondhilaha mandibular**) waxay hore ugu soo durduraysaa meesha ugu sarreysa buurta lafaha ee horteeda godka dhegta (** caanka articular**). Isla markaaba, murqaha dhabannadaada (**masseters**) way soo boodaan oo kondhilejka u soo jiid xagga hore ee buurta lafta, oo ku dabinaysa. Isku day inaad afka hore ee gadhkaaga si toos ah u riixdo ayaa lafta si adag uga soo horjeeda buurta; takhtarku waa inuu marka hore ku cadaadiyaa **Ilkaha dabada dhabarka hoose** (ama ha ku rogto foosto saliingaha u dhaxaysa gowsaha dhabarkaaga) si aad u nadiifiso buurta lafaha ka hor inta aanu daanku dib ugu laaban godkiisa.

Sidee baa kaniiniga lallabbo-labo sida Reglan ama Compazine uga dhigi karaa daanka aan kala go'o?¶

Daawooyinka ka hortagga lalabo sida metoclopramide (Reglan) iyo prochlorperazine (Compazine), iyo sidoo kale dawooyinka dhimirka sida haloperidol ama risperidone, waxay xannibaan daaweeyayaasha dopamine ee ganglia basal ee maskaxda. Dadka qaarkiis, gaar ahaan carruurta, dhalinyarada, iyo dadka da'da yar, tani waxay kicisaa muruq muruq oo degdeg ah oo loo yaqaan **acute dystonic reaction (oromandibular dystonia)**, halkaasoo muruqyada pterygoid ay si xoog leh u jiidayaan daanka ballaaran ama dhinac. Cirbadda xididka ah ee **diphenhydramine (Benadryl) ama benztropine** ee qolka gargaarka degdegga ah waxay beddeshaa murqaha muruqa daqiiqado gudahood.

Maxay tahay sababta ay qof dhabarka ugu dhejiyaan bareelo aad khatar u ah marka daanka hoose uu ka jabo labada dhinac?¶

Carrabkaagu wuxuu si toos ah ugu xidhan yahay dhinaca dambe ee gudaha ee lafta garka hore (** mandibular symphysis**). Caadiyan, qaansada adag ee laftaada hoose ayaa garkaada iyo carrabkaaga hore u haysa kana fogaysa dhuunta dabayshaada. Marka daanka hoose uu ka jabo labada dhinac ee garka (** laba geesoodka ah "flail" ama "baaldi-gacan" jab ***), garka hore ayaa go'aya. In dhibbanaha dhabarka loo dhigo waxay sababtaa cufisjiid inuu ku soo daaho jabkii garka ee jabay, carrabkuna si toos ah ugu soo celiyo dhuunta, kuna caburiso haddii aanay hore u fadhiisanayn ama qof uu gadhka iyo carrabkiisa hore u soo jiido.

Maxaa daanka jaban ee ciridka uu ka dhiigbaxayo labada ilig dhexdooda maxaa loola dhaqmaa sida "jajab xarun furan"?¶

Xataa haddii maqaarka dibadda ee dhabankaaga iyo gadhkaagu aanu lahayn xagtin eber, jeebka seedaha microscopic ee ku wareegsan xididka ilig kasta (** seedaha periodontal**) waxay si toos ah ugu xidhaa dhuuxa daanka. Mar kasta oo uu jab jabku ka dillaaco laba ilkood oo uu jeexjeexo cirridka afka ku jira, candhuufta bini'aadamka, oo ay ku jiraan boqollaal milyan oo bakteeriyada ah halkii millilitar, waxay si toos ah ugu qulqulaan lafta jabtay ee cayriin, taas oo ka dhigaysa ** dillaac furan ** oo u baahan antibiyootiko dhakhtar si looga hortago caabuqa lafaha (** osteomyelitis**).

Waa maxay sababta dhakhaatiirta iyo kalkaaliyayaasha caafimaadku ay si adag uga mamnuuceen inay tuubada neefsashada ama tuubada caloosha geliyaan sanka ka dib shil waji dhexe (Le Fort)?¶

Jabka dhexe ee Le Fort II ama Le Fort III, ama dhaawac kasta oo keena indho madow oo laba geesood ah ("indhaha raccoon"), nabar dhegaha gadaashiisa ah ("Calaamadda Dagaalka"), ama buundada sanka ee jajaban, waxay inta badan dildilaacaysaa saxanka khafiifka ah ee ** saxan saxan ah oo ah lafta ethmoid ** kaas oo sameeya saqafka saqafka sanka iyo sagxada qolka maskaxda. Riixitaanka marin-haweedka sanka ee dabacsan ama tuubada sanka ee sanka marka saxanka lafta uu dillaaco waxay u diri kartaa tuubada si toos ah saqafka sanka ** gudaha xuubabka hore ee maskaxda ***; Tuubooyinka oo dhan waa inay afka ka gudbaan.

Mar haddii daanka iga go'ay uu dib ugu soo noqdo meeshii qolka gargaarka degdegga ah, sidee baan u joojin karaa inay mar kale dhacdo?¶

Mar kasta oo ku-meel-gaadhka ah ee ku-meel-gaadhka ah ee kala-goysyada, kaabsalka seedaha ee haya kubbadda wadajirka ayaa soo baxa, taasoo ka dhigaysa kala-baxyada ku-noqoshada ah 2da toddobaad ee ugu horreeya. Si adag ugu dheji cuntooyinka jilicsan ee u baahan eber qaniinyo ballaaran 10 ilaa 14 maalmood, iska ilaali inaad afkaaga u kala qaaddo in ka badan hal far oo ballac ah, iyo ** had iyo jeer feedhkaaga si adag ugu cadaadi gadhkaaga hoostiisa mar kasta oo aad dareento hamaansi, hindhiso, ama qosol bilawga ** si aad uga ilaaliso daankaaga inuu si ballaaran u furo.

Tilmaamaha la xidhiidha¶

• Xaaladaha degdega ah ee ilkaha iyo daryeelka iliga ee la garaacay
• Mareegta iyo xannibaadda marin-haweedka gargaarka degdegga ah
• Dhaawac madaxa iyo miyir beelka
• Dhaawacyada laf dhabarta iyo dhaqdhaqaaq la'aanta

Ilaha iyo hanuuninta rasmiga ah¶

• Kuliyada Dhakhaatiirta Qalliinka Mareykanka (ACS, Mareykanka) Guddiga Dhaawaca: *Taageerada Nolosha Sare ee Dhaawaca (ATLS) Buugga Koorsada Ardayga
• Ururka Mareykanka ee Dhakhaatiirta Afka iyo Maxillofacial (AAOMS, United States): Xeerarka Daryeelka: Tilmaamaha Dhaqanka Kiliinikada ee Qalliinka Afka iyo Maxillofacial (Dhiiraan iyo Maareynta Wadajirka Wadajirka ah ee Ku-meel-gaarka ah).
• Ururka Ingiriiska ee Dhakhaatiirta Afka iyo Maxillofacial (BAOMS) iyo Machadka Qaranka ee Caafimaadka iyo Sareynta Daryeelka (NICE, Boqortooyada Ingiriiska):
• ** Golaha Dib-u-soo-nooleynta Yurub (ERC) iyo Ururka Yurub ee Qalliinka Cranio-Maxillo-Wajiga (EACMFS):** * Tilmaamaha Maareynta Marinnada Hawada ee Dhaawacyada Maxillofacial Traumatic*.
• ** College of American Emergency Physicians (ACEP, United States):** *Nidaamka Kiliinikada ee Daawada Degdegga ah: Yaraynta Kala-baxa Wadajirka ah ee Ku-meel-gaadhka ah (Syringe-Roll, Extraoral, iyo Farsamooyinka Intraoral) iyo Xaqiijinta Tijaabada Qaniinyada Afka.