Alterações cromossômicas e periostite / Chromosomal alterations and periostitis

Introdução: A periostite é uma inflamação do periósteo que pode se estender para os tecidos moles adjacentes. Há pouca informação na literatura sobre alterações genéticas nessas lesões, as quais são reparadas por intensas reações de proliferação osteoblástica e possuem curso clínico semelhante ao das osteomielites crônicas inespecíficas, que podem evoluir para neoplasias. Objetivo: análise citogenética de amostra de periostite para detecção e descrição de alterações cromossômicas, principalmente as associadas com desenvolvimento de neoplasias. Métodos: material obtido de lesão em palato de paciente, um homem de 74 anos de idade, submetido anteriormente a cirurgias de remoção de carcinoma basocelular em nariz e cavidade oral. Após a coleta, com estudo histopatológico confirmando apenas material de periostite, a amostra foi submetida à análise citogenética a partir de cultura de células e bandamento GTG. Resultados: o cariótipo composto evidenciou, como alterações clonais, monossomia dos cromossomos 10, 15, 20 e 22; trissomia do cromossomo 22; inversão do cromossomo 12 e deleção de 15q. O grande número de alterações cromossômicas estaria relacionado com a alta taxa de proliferação celular, a qual poderia induzir replicação celular desbalanceada e instabilidade genética. Há genes, envolvidos com desenvolvimento de neoplasias, localizados nos pontos de quebra das alterações estruturais encontradas nos cromossomos 12 e 15. Conclusão: foram evidenciadas várias alterações cromossômicas que refletiriam a proliferação celular local. A análise citogenética em casos de periostite poderá auxiliar na descoberta de biomarcadores de prognóstico e ser utilizada, futuramente, na rotina médica para um melhor manejo dos pacientes.

Introduction: Periostitis is an inflammation of the soft tissues adjacent to the bone that affects the periosteum. There is little information in the literature about genetic alterations in these lesions, which are repaired by intense osteoblast proliferation reactions and present a clinical course that resembles that of nonspecific chronic osteomyelitis that may progress to neoplasms. Objective: Cytogenetic analysis of periostitis sample for detection and description of chromosomal alterations, especially those associated with cancer development. Methods: Material obtained from a palate lesion of a 74-year-old man who had previously undergone surgery to remove basal cell carcinoma in the nose and oral cavity. After collection, with a histopathological study confirming only periostitis material, the sample was submitted to a cytogenetic analysis from cell culture and GTG banding. Results: The composite karyotype showed, as clonal alterations, monosomy of chromosomes 10, 15, 20, and 22; trisomy of chromosome 22; inversion of chromosome 12, and deletion of 15q. The large number of chromosomal alterations would be related to the high rate of cell proliferation, which could induce unbalanced cell replication and genetic instability. There are genes, which are involved in the development of neoplasms, mapped at the breakpoints of structural changes found on chromosomes 12 and 15. Conclusion: Several chromosomal alterations that were observed would reflect local cell proliferation. Cytogenetic analysis of periostitis may help in the discovery of prognostic biomarkers and may be used in the medical routine for better patient management in the future.

Florid Reactive Periostitis of the Proximal Phalanx-Case Report and Literature Review / Periostite reativa florida da falange proximal - relato de caso e revisão de literatura

Abstract Florid reactive periostitis is a benign andrare lesion that is a recurrent diagnostic problem. Its etiopathogenesis remains unknown. Florid reactive periostitis consists of a fibrotic, cartilage- producing tumor accompanied by an aggressive inflammatory periosteal and soft tissue reaction. It typically occurs in adolescents and young adults, mostly female; it often affects hand and foot bones, and it may occur in long bones. Its diagnosis remains a major challenge due to the vast possibility of differential diagnoses. Therefore, careful clinical, radiological, and pathological evaluation is required to establish a proper diagnosis. We report the case of a patientwith florid reactive periostitis in the proximal phalanx of the right index finger, who underwent surgical excision with a wide margin, from the second ray to the proximal third of the secondmetacarpal bone, and evolved without complications,with satisfactory range of motion and strength.

Resumo A periostite reativa florida éumalesão benigna e rara que constitui umproblema recorrente de diagnóstico. Sua etiopatogênese permanece desconhecida. A periostite reativa florida caracteriza- se por ser uma reação periosteal agressiva e inflamatória de tecido mole e por ser um tumor portador de fibrose e produtor de cartilagem. Ocorreemadolescentes e adultos jovens, com predomínio no sexo feminino, e acomete com frequência os ossos das mãos e pés, podendoacometer tambémossos longos.Odiagnósticopermaneceumgrandedesafiodevido à enorme possibilidade de diagnósticos diferenciais. Por isso, uma cuidadosa avaliação clínica, radiológica e patológica é necessária para fechar o diagnóstico. Relata-se o caso de umpaciente com periostite reativa florida na falange proximal do segundo dedo da mão direita, que foi submetida à excisão cirúrgica com margem ampla do segundo raio até o terço proximal do segundometacarpo, e evoluiu semqueixas, comamplitude demovimento e força satisfatória.

Short-Term Surgical Outcome of the Partial Nail Extraction in Ingrown Nail of Military Trainee: Is Matrixectomy Necessary? / 대한족부족관절학회지

PURPOSE: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. MATERIALS AND METHODS: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. RESULTS: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. CONCLUSION: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

Dental students' ability to detect maxillary sinus abnormalities: A comparison between panoramic radiography and cone-beam computed tomography

PURPOSE: To compare the diagnostic ability of undergraduate dental students to detect maxillary sinus abnormalities in panoramic radiographs (PR) and cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This was a retrospective study based on the evaluation of PR and CBCT images. A pilot study was conducted to determine the number of students eligible to participate in the study. The images were evaluated by 2 students, and 280 maxillary sinuses were assessed using the following categories: normal, mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, antrolith, and antrolith associated with mucosal thickening. The reference standard was established by the consensus of 2 oral radiologists based on the CBCT images. The kappa test, receiver operating characteristic curves, and 1-way analysis of variance with the Tukey-Kramer post-hoc test were employed. RESULTS: Intraobserver and interobserver reliability showed agreement ranging from substantial (0.809) to almost perfect (0.922). The agreement between the students' evaluations and the reference standard was reasonable (0.258) for PR and substantial (0.692) for CBCT. Comparisons of values of sensitivity, specificity, and accuracy showed that CBCT was significantly better (P<0.05). CONCLUSION: CBCT was better than PR for the detection of maxillary sinus abnormalities by dental students. However, CBCT should only be requested after a careful analysis of PR by students and more experienced professionals.

Caso clínico: hipofosfatasia de la niñez. Seguimiento clínico / Clinical case: childhood hypophosphatasia. Clinical follow-up

La hipofosfatasia (HP) es una enfermedad congénita, causada por mutaciones con pérdida de función en el gen ALPL que codifica la isoenzima no específica de tejido de la fosfatasa alcalina (TNSALP). Su expresión clínica es muy variable, desde casos de muerte intraútero por alteración grave de la mineralización ósea, hasta casos solo con caída prematura de la dentición. Se presenta el caso clínico de un varón al que se le diagnosticó odontohipofosfatasia a los 30 meses por pérdida temprana de piezas dentarias y niveles anormalmente bajos de fosfatasa alcalina, sin signos de raquitismo ni deformidades óseas. Durante su seguimiento, hasta los 13 años, presentó síntomas compatibles con HP infantil leve, como cansancio al caminar, incoordinación en la marcha y dolor en miembros inferiores que aumentaban con la actividad física. Ante la aparición de edema bimaleolar y poca respuesta al tratamiento con calcitonina y antiinflamatorios, se descartaron patologías infecciosas o reumáticas o ambas y se diagnosticó, por biopsia de tibia y peroné, periostitis sin detección de cristales de pirofosfato. Los controles radiológicos durante su evolución mostraron ensanchamiento metafisario en muñeca, falta de remodelado de metacarpianos, hojaldrado perióstico en tibia y peroné e hipomineralización en metáfisis tibiales, con "lenguas radiolúcidas" características de HP. Como conclusión, la hipofosfatasia debe considerarse como una entidad clínica para descartar en niños que presentan pérdida temprana de dientes. La presencia de este cuadro clínico es en general suficiente para realizar el diagnóstico de HP de la niñez. (AU)

Hypophosphatasia (HP) is a congenital disease, caused by mutations with loss of function in the gene ALPL that encodes the non-specific tissue isoenzyme of alkaline phosphatase (TNSALP). Its clinical expression displays considerable variability, from cases of intrauterine death due to severe alteration of bone mineralization, to cases with only early loss of teeth. We report the case of a male, diagnosed as odontohypophosphatasia at 30 months of age due to early loss of teeth and abnormally low levels of alkaline phosphatase, without signs of rickets or bone deformities. During follow-up, up to 13 years of age, he presented symptoms consistent with mild infantile HP such as tiredness when walking, lack of gait coordination, and pain in lower limbs, especially after physical activity. Due to the appearance of bimalleolar edema and poor response to treatment with calcitonin and anti-inflammatory drugs, infectious and / or rheumatic pathologies were ruled out. Periostitis without pyrophosphate crystal detection was diagnosed by tibial and fibular biopsy. Radiological controls during follow up showed metaphyseal wrist enlargement, lack of remodeling of metacarpals, periosteal flaking in the tibia and fibula and hypomineralization in the tibial metaphysis, with "radiolucent tongues"; characteristic of HP. In conclusion, hypophosphatasia should be considered as a clinical entity in children who present early loss of teeth. The presentation of this clinical case is generally sufficient to make the diagnosis of childhood HP. (AU)

Congenital syphilis with bone lesion: case report / Sífilis congênita com lesão óssea: relato de caso

ABSTRACT The authors report a case of congenital syphilis in a newborn with a bone lesion, resulting in left ankle periostitis.

RESUMO Os autores apresentam um caso de um recém-nascido portador de sífilis congênita com lesão óssea que evoluiu com periostite no tornozelo esquerdo.

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction / Osteomielite crônica multifocal recorrente exibindo predomínio de reação periosteal

Summary Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.

Resumo Osteomielite crônica multifocal recorrente é uma desordem autoinflamatória óssea idiopática não piogênica, envolvendo vários sítios e com evolução clínica persistindo por mais de 6 meses, podendo apresentar episódios de remissão e exacerbação em longo prazo. Representa de 2 a 5% das osteomielites, com incidência aproximada de até 4/1.000.000, com idade média de apresentação estimada entre 8 e 11 anos, predominando no gênero feminino. Os membros inferiores são os mais afetados, com predileção para regiões metafisárias junto à fise. Descrevemos um caso da doença em uma menina de 2 anos e 5 meses de idade, com acometimento de ulna esquerda, mandíbula à direita e tíbia esquerda, exibindo predomínio de reação periosteal como achado principal.

Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases

In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.

Aproximación en la identificación de factores de riesgo extrínsecos del síndrome de estrés tibial interno en cadetes de la Escuela Militar Bogotá, Colombia / Approach in identifying extrinsic risk factors of the medial Tibial Stress syndrome on cadets of the Military Academy Bogotá, Colombia

El síndrome de estrés tibial interno es una enfermedad frecuente en el personal militar durante los primeros meses de su entrenamiento. Su etiología no es muy clara y en diferentes trabajos se han descrito varios factores intrínsecos de riesgo relacionados con este síndrome, pero poco se han enfocado en identificar factores extrínsecos de riesgo en el personal militar. Objetivo: Hacer una aproximación a la identificación de los factores extrínsecos de riesgo relacionados con el síndrome de estrés tibial interno en personal militar de primer y segundo nivel de la Escuela Militar de Cadetes “General José María Córdova”. Metodología: La muestra la conformaron100 cadetes de la facultades de Educación Física Militar, de Ingeniería Civil y de Ciencias Militares, que contestaron dos cuestionarios: en uno se buscó identificar la presencia de síntomas y signos activos del síndrome de estrés tibial interno y, en el otro, los factores de riesgo descritos en la literatura y aquellos que a consideración del investigador podrían relacionarse con este síndrome. Resultados: El 21 % de los cadetes presentó el síndrome de estrés tibial interno. Los factores extrínsecos de riesgo identificados fueron: percibir el calzado deportivo de dotación como similar al calzado particular y realizar “repetición de la actividad” como correctivo en la formación militar. Los factores protectores identificados en los cadetes fueron: correr menos de 10 km, tener un acumulado de 20 a 30 km utilizando el calzado de dotación, percibir el calzado de dotación como pesado o similar al calzado común, desarrollar los entrenamientos físicos de su formación militar sobre la grama y realizar el correctivo militar “trote alrededor de la escuela”. Conclusion: Se logró determinar que considerar el calzado deportivo de dotación como inadecuado para el entrenamiento deportivo y someterse al correctivo militar...

Introduction: The medial tibial stress syndrome (MTES) is a common condition in military personnel during the first months of their training. Its etiology is unclear and different studies have described several intrinsic risk factors associated with this syndrome, but few have focused on identifying extrinsic risk factors in military personnel. Objective: The central aim of the study was to make an approach to the identification of extrinsic risk factors related to MTES in first year academy military personnel. Methodes: The sample consisted of 100 first year military personnel attending the physical education, civil engineering and military science pregraduate majors. They answered two questionnaires, one sought to identify cadets who had symptoms and signs of active MTES, and the second questionnaire sought to identify risk factors described in the literature and those that the researcher considered to be related to this syndrome. Results: 21% of the military personnel had MTES, and the extrinsic risk factors identified in the cadets were: perceiving the military issued sneakers as usual to the regular footwear and performing “repetition of the activity” as a corrective measure as part of the military training. Protective factors identified in the military personnel were: running less than 10 km, to have a total accumulated of 20 to 30 km using military issued boots, to perceive military issued footwear as heavy or usual to common footwear, to do the physical military training over grass and to “run to the academy premises” as a corrective measure in their military training. Conclusions: It was possible to identify that the military personnel who perceived as inadequate the military issued sneakers to perform their sports training and the military ...

Proliferative periostitis of the mandibular ramus and condyle: a case report

Proliferative periostitis is a rare form of osteomyelitis that is characterized by new bone formation with periosteal reaction common causes of proliferative periostitis are dental caries, periodontitis, cysts, and trauma. While proliferative periostitis typically presents as a localized lesion, in this study, we describe an extensive form of proliferative periostitis involving the whole mandibular ramus and condyle. Because the radiographic findings were similar to osteogenic sarcoma, an accurate differential diagnosis was important for proper treatment.

A Case of Pachydermoperiostosis Combined with Undifferentiated Arthritis

Pachydermoperiostosis (PDP) is a primary hypertrophic osteoarthropathy characterized by digital clubbing, pachydermia, and periostosis, which is inherited as an autosomal dominant or recessive trait. We report on a patient suffering from bilateral knee arthritis for 6 years who was newly diagnosed as PDP. PDP was confirmed by bilateral digital clubbing, hyperhidrosis, and cutis verticis gyrata, findings of pachydermatosis on the forehead and scalp, X-ray findings of proliferative periostitis. This case indicates that PDP is one of several possible rare diseases that should be considered in patients with undifferentiated arthritis.

Psoriatic Onycho-pachydermo-periostitis of the Fingertips: A Report of Two Cases

Psoriatic onycho-pachydermo-periostitis (POPP) causes severe nail dystrophy, painful soft tissue swelling, and marked periosteal reaction of the involved distal phalanx. There are few reports of POPP involving the great toe. We report on 2 cases of POPP involving the fingertips. A 60-year-old woman presented with fusiform swelling of her right 4th fingertip with severe tenderness, and her fingernails and toenails had varying degrees of onycholysis. She had mixed multiple erosions and meta-epiphyseal periostitis at the distal phalanx of the right 4th finger but was treated successfully with methotrexate and cyclosporine. A 39-year-old woman presented with painful swelling of the left 2nd and 5th fingertip, psoriatic lesions on the knees and soles of the feet, and onycholysis without reactive periostitis of the left 2nd and 5th fingers. She was treated successfully with cyclosporine. Despite its rarity, POPP should be considered when diagnosing arthritic or infectious conditions affecting the distal interphalangeal joint.

O papel do periósteo nos procedimentos ortopédicos como exemplo de sua capacidade reparatória / The role of the periosteum in orthopedic procedures: an example of its reparative ability

Na Ortopedia, o periósteo adquire relevância por estar associado à morfologia óssea, que pode ser modificada pelas demandas funcionais, contribuindo enormemente com o dinamismo oferecido pela remodelação, ou turnover, óssea. Estudar mais profundamente a capacidade adaptativa, reacional e reparatória do periósteo nos permite entender: 1) o comando dos osteócitos na determinação da morfologia óssea, inclusive durante o movimento dentário induzido; 2) a expansão rápida do palato e as mudanças ocorridas na forma da maxila; 3) o deslocamento mandibular por aparelhos ortopédicos funcionais; 4) a etiopatogenia da periostite ossificante, antigamente denominada de osteomielite de Garrè; 5) a “expansão” das corticais durante os crescimentos císticos e tumorais. Nesse trabalho, discorre-se sobre os eventos celulares e teciduais das reações periosteais e suas extrapolações clínicas.

Hypertrophic Osteoarthropathy in Patient with Crohn's Disease: A Case Report

Numerous causes of hypertrophic osteoarthropathy (HOA) have been reported. Commonly, secondary osteoarthropathy accompanies pulmonary diseases such as carcinoma of the lung, pleural tumors, lung abscesses, and bronchiectasis. However, HOA in inflammatory bowel disease is a rare complication. There are only a few reports of secondary HOA with Crohn's disease. Our purpose was to report another case of HOA in Crohn's disease. We describe a case of a 27-year-old man with underlying Crohn's disease presenting with 2 years of pain in multiple joints. Radiographic findings suggested HOA in extremities. We performed a conservative treatment including medication and rehabilitations. The patient's symptoms were much improved at the latest follow-up. Although numerous studies on HOA have been published, the pathogenesis of HOA is still unclear. Various treatment modalities were recommended but further studies to uncover the pathogenesis of HOA with Crohn's disease and to establish a treatment modality are needed.

Osteomielitis crónica con periostitis proliferativa / Chronic osteomyelitis with proliferative periostitis

La osteomielitis crónica con periostitis proliferativa es un tipo de alteración caracterizada por una reacción periosteal exacerbada causada por un estimulo de baja intensidad, generalmente una lesión cariosa con patología periapical asociada. Actúa principalmente en niños y adolescentes con predilección por la región basilar de mandíbula. Clínicamente, se manifiesta a través de un aumento de volumen doloroso intra o extraoral, de consistencia endurecida. Radiográficamente presenta laminas óseas neoformadas, paralelas entre si con superficie cortical, observándose el aspecto típico de "cascara de cebolla". El tratamiento incluye el retiro del factor etiológico con o sin antibioterapia y posterior restablecimiento de la simetría facial del paciente. Este trabajo presenta un caso de osteomielitis crónica con periostitis proliferativa en una paciente de sexo femenino de 11 años de edad, causada por una lesión cariosa en el primer molar inferior izquierdo, quien fue sometida a exodoncia del diente comprometido con posterior restablecimiento de la simetría facial.

Chronic osteomyelitis with proliferative periostitis is a kind of osteomyelitis that is characterized by a great periosteal reaction resulting of low grade stimulation, usually a caries lesion associated a periapical pathology. It affects especially children and young adults, with the mandible as the most common site, usually in the inferior aspect. Clinically presents as a painless hard swelling intra and/or extra-oral. Radiographic aspects include bone layers new formed, parallel to each other and to the underlying cortical surface, giving the characteristic appearance of "onion skin". Treatment includes elimination of the cause, with or without antibiotics, being restored the facial symmetry of patient. The present article is a clinical case report of chronic osteomyelitis with proliferative periostitis affecting a female 11 year old patient, caused by a caries lesion in the left permanent first molar, that was submissed to a exodontia and the facial symmetry of the patient was restored with management.

Evidence of Periostitis in Joseon Dynasty Skeletons / 체질인류학회지

Periostitis is one of the human diseases commonly encountered in archaeological samples. It is known to be an important health indicator for paleopathologists examining skeletal remains. In our recent study on a Joseon skeletal series (n=101), non-specific, primary periostitis was observed only in five individuals (#4, #29, #137, #175, and #290). Notably, there were no secondary periostitis-suggestive signs (e.g. syphilis), except for those caused by fractures (#33 and #41). As this is the inaugural Korean-skeletal-series report on periostitis, the results presented in these pages should prove significant to interested paleopathologists.

Osteomielite crônica com periostite proliferativa: revisão de literatura

Devido à importância em estabelecer um correto diagnóstico radiográfico, pela dificuldade em diferenciar a osteomielite crônica com periostite proliferativa (OCPP) com outras doenças e devido à importância das imagens no controle da regressão da lesão durante o tratamento, foi realizada uma revisão de literatura dobre a OCPP, com ênfase nos aspectos de imagens (radiográfico e tomográfico). Além de abordar as características clínicas e histopatológicas. Os critérios de inclusão foram trabalhos de investigações científicas, revisões de literatura e relato de casos clínicos...

Transplantar lâminas de cortical com periósteo cria um novo ambiente para a osteogênese e osseointegração: fundamentos, ou, Biologia do reparo ósseo em restauração dentoalveolar imediata, ou, Por que na restauração dentoalveolar imediata o transplante não necrosa ou sequestra / Transplant cortical blades of periosteum creates a new environment to osteogenesis and osseointegration: fundamentals, or, Biology of bone repair in immediate dentoalveolar restoration, or, Why in immediate dentoalveolar restoration a transplant does not necrose or sequester

Na técnica da Restauração Dentoalveolar Imediata o reparo ósseo observado quando associado ao sucesso clínico funcional e estético permitiu-nos ressaltar o papel biológico do periósteo na sua função de compartimentalizar o ambiente ósseo e também a sua capacidade reacional osteogênica. O periósteo sobre a cortical impede que células dos tecidos vizinhos colonizem o coágulo sanguíneo e o tecido de granulação nas cavidades e superfícies ósseas. Além de atuar como barreira física, o periósteo fornece os vasos sanguíneos para os ossos e apresenta uma efetiva capacidade osteogênica reacional frente a estímulos de baixa intensidade e longa duração caracterizada por novas camadas ósseas depositadas sobre a cortical, um fenômeno denominado de Periostite Ossificante.