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Oral Pathology Flashcards

(169 cards)

1
Q

Diagnosis and Treatment of the following condition

  • Usually affects children 2-10 years old
  • Short, thick lingual frenum
  • May impair breastfeeding
  • May cause localized Gingival Recession of a lower incisor
  • May cause speech difficulties
A

Ankyloglossia |Tongue-tie
- Frenuloplasty in case of Gingival recession
- Frenuloplasty at age 4-5 in case of speech problems
- Early Frenotomy in case of Breastfeed impairment

Etiopathogenesis: Developmental anomaly caused by a short lingual frenum that restricts tongue movement

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2
Q

Diagnosis of the following condition

  • Acrobrachycephaly (tower skull), with severe cases causing cloverleaf skull. The occiput is flattened, and a tall forehead is observed.
  • Exophthalmos, Hypertelorism and downward-slanting lateral palpebral fissures
  • Syndactyly of the second, third, and fourth digits on hands and feet
  • Visual loss due to chronic eye exposure, increased intracranial pressure and optic nerve compression
  • There frequently is cognitive impairment
  • Midface hypoplasia, that may cause respiratory issues, mouth breathing, sleep apnea, and middle-ear infections
  • Class III Skeletal Relationship, causing Anterior Open Bite and Anterior Crossbite
  • V-shaped dental arch, causing Crowding despite Hypodontia
  • Shovel-shaped incisors
  • Trapezoid-shaped lips, cleft of the soft palate or Bifid Uvula
  • Gingival thickening potentially delaying tooth eruption
  • Increased digital markings, creating “beaten-metal” pattern in radiographs
A

Apert Syndrome | Acrocephalosyndactyly

Etipathogenesis: Craniosynostosis Syndrome (caused by the premature fusion of the fontanelles

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3
Q

Diagnosis and Treatment of the following condition

  • Asymptomatic swelling in the lateral portion of the neck, anterior to the sternocleidomastoid muscle
  • May also form in the submandibular area, adjacent to the parotid gland, or around the sternocleidomastoid muscle
A

Branchial Cleft Cyst | Cervical Lymphoepithelial Cyst
Surgical Excision

Etiopathogenesis: Cystic development of remnants of the 2nd Branchial Arch or pouch

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4
Q

Diagnosis of the following condition

  • Asymptomatic, white-yellow swelling in the floor of the mouth smaller than 1.5cm
  • Cystic cavity lined by stratified squamous epithelium without rete ridges
  • Parakeratinized Epithelium, which may contain mucous cells, with desquamated epithelial cells seen filling the cyst lumen
  • Lymphoid tissue in the cyst wall
A

Oral Lymphoepithelial Cyst

Etiopathogenesis: Cystic development of remnants of the 2nd Branchial Arch or pouch

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5
Q

Diagnosis and Treatment of the following condition

  • Usually affects children <5
  • Lesions progress until puberty, when they stabilize and regress
  • Orbital wall lesions may tilt the eyeballs and cause “eyes upturned to heaven” and “puffy cheeks”
  • Usually affects the mandible, causing bilateral bony expansion
  • Intraorally, hard, non-tender swellings may be palpated
  • Tooth displacement and mobility, failure of tooth eruption, impaired mastication, speech difficulties
  • Bilateral, multilocular, expansile radiolucencies, creating Soap Bubble
  • Maxillary antrum obliteration
  • Numerous fibroblasts and multinucleated giant cells with prominent nuclei
  • Eosinophilic, cuff-like deposits of collagen surrounding small blood vessels
A

Cherubism
Enucleation of severe cases

Etiopathogenesis: Autosomal dominant inheritance leading to abnormal bone resorption and formation, causing lytic bone lesions

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6
Q

Diagnosis of the following condition

  • Multiple Supernumerary Teeth, frequently affecting tooth eruption
  • Narrow and high-arched palate
  • Small or absent maxillary sinus, thin zygomatic arch
  • Abnormal spacing in mandibular incisor area, with patent mandibular symphysis
  • Mandibular prognathism, pointy coronoid process with distal curvature, narrow mandibular ramus
  • Increased prevalence of Cleft Palate
  • Hearing loss and recurrent ear infections
  • Delayed or impediment of cranial suture closure
  • Hypertelorism, broad-based nose and depressed nose bridge
  • Enlarged skull, specially with frontal and parietal bossing, brachycephaly and shortened skull
  • Short stature
  • Long neck and narrow shoulders
  • Missing or hypoplastic clavicles, unilaterally or bilaterally, with hypermobility of the shoulders
A

Cleidocranial Dysplasia| Cleidocranial Dysostosis

Etiopathogenesis: Genetic mutation of the RUNX2 gene, interfering with osteoblastic differentiation, chondrocyte maturation, and bone formation

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7
Q

Diagnosis and Treatment of the following condition

  • Affects most frequently males
  • Peak severity in late teenage years
  • Elongation of coronoid process
  • Usually bilateral, causing opening limitation
  • If unilaterally, causes mandibular deviation towards the affected side
  • Painless
A

Coronoid Hyperplasia
Surgical reduction of coronoid process

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8
Q

Diagnosis of the following condition

Asymptomatic Imprints of teeth on the lateral surface of the tongue

A

Crenated Tongue | Scalloped tongue

Frequently associated to Macroglossia

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9
Q

Diagnosis of the following condition

  • Underdevelopment of the midface, brachycephaly, calcified stylohyoid ligaments
  • Dental Crowding, Hypodontia, Angle’s Molar Class III and Posterior Crossbite
  • Exophthalmos, possibly leading to visual impairment or blindness
  • Hearing deficits, cognitive impairment
  • Increased intracranial pressure that may cause headaches
  • May be associated with Orofacial Clefts
  • Increased digital markings, creating “beaten-metal” pattern in radiographs
A

Crouzon’s Syndrome

Etiopathogenesis: Craniosynostosis Syndrome between the maxilla and the wall of the orbit

Risk Factors:
* Increased paternal age

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10
Q

Diagnosis and Treatment of the following condition

  • Affects mostly children and young adults, some being congenital
  • Slow-growing, asymptomatic swelling in the midline of the floor of the mouth
  • Rubbery aspect, retaining pits after pressure application
  • Lesions above the geniohyoid muscle cause upwards the tongue displacement, causing trouble eating, speaking or breathing
  • Lesions below the geniohyoid muscle cause a double-chin appearance
  • Orthokeratinized stratified squamous epithelium lining with a prominent granular cell layer
  • Abundant keratin in the cystic lumen
  • Epithelial lining may contain areas of respiratory epithelium
  • Cystic wall consisting of fibrous connective tissue, with skin adnexal structures (hair, sweat glands, sebaceous glands)
A

Dermoid Cyst | Dysontogenic Cyst
- Supra geniohyoid lesions: surgical excision by intraoral approach
- Infra geniohyoid lesions: surgical excision by extraoral approach

Etiopathogenesis: Benign Teratoma of epidermis-like tissue

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11
Q

How can a Dermoid Cyst and a Ranula be differentiated clinically?

A

Dermoid Cysts occur in the midline, whereas Ranulas occur off the midline

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12
Q

Diagnosis and Treatment of the following condition

  • Vague facial pain, especially while swallowing, turning the head, or opening the mouth
  • Dysphagia, Dysphonia, otalgia, headache, dizziness
  • Severe manifestations: Vasodepressor Syncope and transient ischemic attacks
  • Mineralization of the stylohyoid ligament
A

Eagle Syndrome | Stylohyoid Syndrome |Carotid Artery Syndrome | Stylalgia
- Mild symptomatic cases benefit from local corticosteroid injection
- Severe cases can be treated with corrective surgery

Etiopathogenesis: - Development of scar tissue with elongation and mineralization of the stylohyoid complex after tonsillectomy, causing Impingement on adjacent nerves and blood vessels

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13
Q

Diagnosis of the following condition

  • Incidence increases with aging
  • Affects most frequently males
  • Multiple grooves or fissures on the tongue surface
  • Usually asymptomatic, but may cause mild burning or soreness
  • Hyperplasia of rete ridges
  • Loss of keratin on filiform papillae
  • Varied papillae size, separated by deep grooves
  • Polymorphonuclear leukocytes migrating into epithelium, sometimes forming microabscesses
  • Mixed inflammatory cell infiltrate in the lamina propria
A

Fissured Tongue | Scrotal Tongue

Risk Factors:
- Geographic Tongue
- Melkersson-Rosenthal Syndrome

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14
Q

Diagnosis of the following condition

  • Identified most frequently in adults
  • Multiple yellow or yellow-white Papules
  • Located most commonly on buccal mucosa and lateral portion of the upper lip’s vermilion
  • Sebaceous glands without hair follicles
A

Fordyce Granules

Etiopathogenesis: Anatomic variation characterized by ectopic presence of sebaceous glands on the oral and/or genital mucosa

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15
Q

Diagnosis of the following condition

  • Midface hypoplasia, protuberant lips, flattened nose, prominent forehead
  • Conical teeth
  • Hypodontia, Oligodontia
  • Salivary Gland Aplasia or hypoplasia and Xerostomia
  • Wrinkling and hyperpigmentation of periocular skin, brittle nails
  • Hypotrichosis: Fine, sparse hair
  • Anhidrosis: Reduced number of sweat glands and heat intolerance
  • More common in males
A

Ectodermal Dysplasia | Christ-Siemens-Touraine Disease

Etiopathogenesis: X-linked recessive mutation that affects ectoderm-derived structures

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16
Q

Diagnosis and Treatment of the following condition

  • Affects most frequently females
  • Tissue-colored, vascular mass situated anywhere from the foramen cecum to the epiglottis
  • May growth enough to cause airway blockage
  • Frequently (70%) represents the only thyroid tissue in the patient
  • Dysphagia, Dysphonia, Dyspnea usually develop after puberty, pregnacy or menopause
  • 1/3 of patients have Hypothyroidism
  • Thyroid scan will show hyperconcentration of iodine isotope in the mass
A

Lingual Thyroid
* Hormone therapy in symptomatic patients
- Surgical removal if hormone therapy is ineffective

Etiopathogenesis: Ectopic deposition of thyroid tissue between the foramen cecum and epiglottis

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17
Q

What are the congenital causes of Macroglossia?

A
  • Vascular Malformations
  • Lymphangioma
  • Hemangioma
  • Cretinism
  • Neurofibromatosis Type I
  • Down Syndrome
  • Multiple Endocrine Neoplasia Type 2B
  • Hemihyperplasia
  • Beckwith-Wiedemann syndrome
  • Duchenne muscular dystrophy
  • Mucopolysaccharidoses
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18
Q

What are the acquired causes of Macroglossia?

A
  • Edentulism
  • Amyloidosis
  • Myxedema
  • Acromegaly
  • Angioedema
  • Myasthenia Gravis
  • Amyotrophic lateral sclerosis
  • Carcinoma and other tumors
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19
Q

Diagnosis and Treatment of the following condition

  • Affects most frequently older adults
  • Most common oral location is the sublingual area
  • Multiple asymptomatic, blue-purple, elevated blebs
  • If thrombosed, the varix appears as a firm, blue-purple nodule and contain lines of Zahn
  • Dilated vein with little smooth muscle and poorly developed elastic tissue
  • Older thrombi may show Dystrophic Calcification, leading to Phlebolith formation
A

Oral Varicosities
Surgical removal indicated in cases of: Esthetic concern or diagnostic confirmation needed

Etiopathogenesis: Age-related degeneration with loss of connective tissue tone supporting the vessels

Risk factors:
- Age
- Smoking
- Cardiovascular disease

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20
Q

Diagnosis and Treatment of the following condition

  • Affects up to 85% of neonates
  • 1-3mm wide white-yellow papules distributed along the median palatal raphe
  • Keratin-filled cyst
  • Squamous stratified epithelium lining
A

Epstein Pearls
Ruptures and heals spontaneously

It is a type of Palatal Cyst of the Newborn

Etiopathogenesis: Developmental cyst derived from epithelium entrapped along the line of fusion during secondary palate formation

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21
Q

Diagnosis and Treatment of the following condition

  • 1-3mm wide white-yellow papules distributed along the palate out of the midline
  • Affects up to 85% of neonates
  • Keratin-filled cyst with squamous stratified epithelium lining
A

Bohn’s Nodules
Ruptures and heals spontaneously

It is a type of Palatal Cyst of the Newborn

Etiopathogenesis: Developmental cyst derived from epithelium entrapped along the line of fusion during secondary palate formation

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22
Q

Diagnosis and Treatment of the following condition

  • Usually bilateral and symmetric depressions on the lower lip
  • May vary from subtle depression to considerable hump
  • May express salivary fluid
  • May be transmitted to offspring as Orofacial Clefts
A

Paramedian Lip Pits | Congenital Fistulas of the Lower Lip
Surgical removal in cases of cosmetic concern

Etiopathogenesis: Congenital malformation that results from persistent lateral sulci from abnormal fusion of the maxillary and mandibular processes

Risk Factors:
- Genetic diseasesVan der Woude Syndrome
- Popliteal Pterygium Syndrome
- Kabuki Syndrome

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23
Q

Diagnosis and Treatment of the following condition

  • Triad of: Cleft Palate, Mandibular micrognathia at birth and Glossoptosis
  • Respiratory difficulty at birth, specially in the supine position
  • Risk of asphyxiation
  • Cleft Palate usually in U shape, wider than isolated cases
A

Pierre-Robin Sequence

Etiopthogenesis: Intrauterine Molding syndrome due to decreased amniotic fluid volume and pressure of the head against the uterine wall

Risk factors
- Stickler Syndrome
- Velocardiofacial Syndrome

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24
Q

Diagnosis and Treatment of the following condition

  • Effects frequently middle-aged men
  • Usually unilateral depression of the lingual surface of the mandible, inferior to the mandibular canal, between the angle of the mandible and the 1st molar
  • Asymptomatic
  • Usually contains normal salivary gland tissue, and may contain a mix of blood vessels, fat, connective tissue and lymphoid tissue, as well as may be totally empty
  • Round, unilocular, well-circumscribed radiolucency with sclerotic borders
  • May occur anteriorly in association with the sublingual gland, superimposing the apices of mandibular anterior teeth
A

Stafne Bone Defect | Stafne Bone Cyst

Etiopathogenesis: Development of ectopical tissue, frequently of salivary glands, in the mandible

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25
How can Stafne Bone Defect be differentiated from other radiolucencies in the same typical location?
Fine-needle Aspiration Biopsy
26
# Diagnosis and Treatment of the following condition - Typically affects young adults - Asymptomatic, movable and fluctuant swelling at the midline from the foramen cecum of the tongue to the suprasternal notch, often adjacent to the hyoid bone - May attach to the hyoid bone or tongue and move along with swallowing and tongue movement - May cause laryngeal obstruction - Columnar, stratified squamous, cuboidal, or even small intestine epithelium lining - May contain thyroid tissue in the cystic wall
**Thyroglossal Duct Cyst** Surgical removal of cyst, hyoid bone segment and muscle tissue associated ## Footnote Etiopathogenesis: Developmental cyst that results from the proliferation of endodermal cells in the embryonic pharynx
27
# Diagnosis and Treatment of the following condition - Usually affects females under 10 - Multiple bones are affected - Irregular Café-au-lait pigmentation that resembles the coast of Maine - Endocrine abnormalities, such as sexual precocity in females, Hyperthyroidism, Hyperparathyroidism, hypercortisolism, excess Growth Hormone - Craniofacial involvement may lead to vision and hearing problems, nasal and sinus congestion and airway obstruction - Tends to slows or cease with puberty - Coxa Vara, bone pain, pathologic fracture, leg length discrepancy, bowing deformity, etc. - Painless, slow-growing, unilateral swelling causing facial asymmetry - Increased risk of malignant transformation - Some lesions may be a mix of radiolucent and radiopaque - Ground-glass Opacification with poorly defined margins - Hypophosphatemia due to renal phosphate waste - Increased Alkaline Phosphatase **Oral Manifestations** - Same as Monostotic Fibrous Dysplasia - Tooth displacement, retained deciduous teeth, Oligodontia - Enamel Hypoplasia, Enamel Hypomineralization - Taurodontism
**McCune-Albright Syndrome | Albright Syndrome** - Symptomatic management - Hormonal therapy - Surgical intervention for deformities - Bisphosphonates for bone pain | Type of **Polyostotic Fibrous Dysplasia** ## Footnote Etiopathogenesis: Mutation of the GNAS gene, altering multiple cell types related to bone metabolism, resulting in replacement of bone with fibro-osseous tissue
28
# Diagnosis and Treatment of the following condition - Hypoplastic zygomas, narrow face, depressed cheeks, and downward-slanting palpebral fissures - Coloboma of the lower eyelid, lack of eyelashes - Ear anomalies that often lead to hearing loss - Marked hypoplasia of the condylar and coronoid processes, antegonial notching, retruded chin - Downturned mouth, Lateral Facial Cleft, Cleft Palate - Salivary Gland Aplasia of the Parotid Gland - Hypoplasia of the airways may cause difficulty breathing
**Treacher-Collins Syndrome | Mandibular Dysostosis | Franceschetti-Zwahlen-Klein Syndrome** ## Footnote Etiopathogenesis: Malformation involving the 1st Branchial Arch and the 2nd Branchial Arch Risk Factor: Increased paternal age
29
# Diagnosis of the following condition - High tendency to have sunburns - Atrophied, freckled skin - Early actinic keratosis - Early development of squamous cell carcinoma and Basal Cell Carcinoma - Squamous cell carcinoma of lower lip and tip of tongue - Neurologic degeneration (20-30% of patients): subnormal intelligence, ataxia, sensorineural deafness, impaired eyesight
**Xeroderma Pigmentosum** ## Footnote Etiopathogenesis: Genetic Impairment of DNA repair, allowing free mutagenic effect of UV light in epithelial cells
30
# Diagnosis and Treatment of the following condition - Affects most frequently individuals of black descent - Bilateral white-translucent wrinkles and streaks that do not rub off - Disappears during mucosal stretch - Parakeratosis, Acanthosis - Intracellular epithelial edema in the stratum spinosum, resulting in large cells with pyknotic nuclei - Broad and elongated rete ridges
**Leukoedema** ## Footnote Etiopathogenesis: Anatomic variation
31
# Diagnosis and Treatment of the following condition - Most common in the posterior third of the tongue, just anterior to the circumvallate papillae, in the midline - Elongated, hair-like papillae of the tongue that may be stained dark due to drinks, foods, smoking or bacteria - May lead to esthetic discomfort, gagging and bad taste in the mouth - Histological elongation and hyperparakeratosis of the filiform papillae, with numerous bacterial growth sites
**Hairy Tongue** - Reduction or elimination of predisposing factors (ie: smoking, alcohol, antibiotics, etc.) - Scraping of the elongated papillae - Improvement of oral hygiene ## Footnote Etiopathogenesis: Idiopathic increase in keratin production or a decrease in keratin desquamation Risk Factors: - Systemic Antimicrobials therapy - Smoking, Alcohol consumption - General debilitation - Poor oral hygiene - Drugs that may induce Xerostomia - Radiation Therapy - Prolonged use of Chlorhexidine or Hydrogen Peroxide mouthwashes
32
# Diagnosis and Treatment of the following condition - Abnormally small mandibular condyle - If bilateral, will result in a small mandible in Class II Skeletal Relationship - If unilateral, will result in depression of the face and midline deviation towards the affected side
**Condylar Hypoplasia** ## Footnote Risk Factors: - Trauma - Infection - Congenital malformation
33
# Diagnosis and Treatment of the following condition - Affects most frequently young adult females - Excessive growth of one mandibular condyle that may involve the body of the mandible - Contralateral deviation on opening - Facial asymmetry, prognathism, Posterior Crossbite, and Posterior Open Bite - May lead to compensatory maxillary growth and tilting of the occlusal plane
**Condylar Hyperplasia** Ortho-surgical treatment in cases of severe functional or esthetic compromise ## Footnote Risk Factors - Local circulatory problems - Endocrine disturbance - Trauma
34
How to differentiate Condylar Hyperplasia from Hemifacial Hyperplasia?
Soft tissue and teeth are not enlarged in Condylar Hyperplasia
35
How to differentiate Condylar Hyperplasia from Osteoma of the mandibular condyle?
Condylar shape is maintained in Condylar Hyperplasia, wheras it is altered in Osteoma of the condyle
36
# Diagnosis and Treatment of the following condition - Usually affects middle-aged females - No bone involvement, occurring exclusively in soft tissue - Unilateral, asymptomatic swelling in the upper lip lateral to the midline, causing elevation of the ala of the nose - Elevation of the mucosa of the nasal vestibule and obliterates the maxillary mucolabial fold - May result in nasal obstruction or may interfere with the wearing of a denture - Pseudostratified columnar epithelial lining - Cyst wall is composed of fibrous connective tissue with adjacent skeletal muscle
**Nasolabial Cyst | Nasolalveolar Cyst | Klestadt Cyst** Enucleation ## Footnote Etiopathogenesis: Cystic development of epithelial remnants of nasolacrimal duct
37
# Diagnosis and Treatment of the following condition - Usually occurs in the mandibular 1st molar area - Adjacent teeth are vital - Asymptomatic, non-expansile, well-defined radiopacity
**Dense Bone Island | Idiopathic Osteosclerosis | Bone Eburnation | Bone Scar | Enostosis | Focal Periapical Osteopetrosis** ## Footnote Etiopathogenesis: Localized increase of bone density of unknown cause
38
How to differentiate a Dense Bone Island from Condensing Osteitis?
It is not caused by odontogenic inflammation, so the associated teeth are usually asymptomatic and show no decay
39
# Diagnosis of the following condition - Usually affects females - Usually affects the posterior mandible in edentulous areas - Asymptomatic, non-expansile, well-defined radiolucency - Hematopoietic cells and fatty marrow in histological examination
**Focal Osteoporotic Marrow Defect** ## Footnote Etiopathogenesis: Enlarged bone marrow that is sufficient to produce a radiolucency Risk Factors: Exodontia
40
# Diagnosis of the following condition - Usually affects children and young adults - Spontaneous and progressive destruction of one or more bones - Bone pain - Risk of pathologic fracture - Increased risk for sleep apnea - Gnathic lesions usually affect the mandible - Teeth respond normally to vitality tests - Mobile teeth, malocclusion, deviation of the mandible, and clinically obvious deformity - Ill-defined radiolucency - Loss of lamina dura and thinning of cortices - Loose, highly vascular connective tissue with a diffuse chronic inflammatory cell infiltrate
**Phantom Bone Disease | Massive Osteolysis | Gorham Disease** ## Footnote Etiopathogenesis: Bone destruction followed by vascular, then fibrous tissue replacement Risk Factors: Trauma
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