[Diffuse sclerosing osteomyelitis of the mandible and SAPHO syndrome].
BACKGROUND
Diffuse sclerosing osteomyelitis of the mandible (DSOM) and SAPHO (synovitis, acne, palmo-plantar pustulosis and psoriasis, hyperosteosis, osteitis) syndrome are not commonly associated. SAPHO has not been described to date in the stomatology and maxillo-facial surgery literature in French. Were report here a homogeneous series of 12 patients with DSOM.


METHODS
All patients had mandibular osteitis.


RESULTS
Five patients with multifocal osteitis wre considered to present SAPHO syndrome because of the associated skin lesions. One patient with a unique focus of mandibular osteitis and palmo-plantar pustulosis probably had early-stage SAPHO syndrome. The diagnosis in the other cases was diffuse sclerosis osteitis of the mandible.


CONCLUSIONS
We compared our series with those reported in the literature, emphasizing diagnostic and therapeutic difficulties. Diffuse sclerosing osteomyelitis of the mandible should be distinguished from microbial osteitis. Early diagnosis is required to avoid successive and unnecessary dental avulsions. There is a possible link between DSOM and SAPHO and all patients should have a complete work-up including whole-body scintigraphy to search for other foci. A biopsy is indicated to rule out malignancy. Nonsteroidal antiinflammatory drugs can improve patient comfort in this particularly long syndrome. Although the efficacy is demonstrated, surgery and antibiotics can only delay relapse for a few months.
Fleuridas
G
G
U.F.R. de Stomatologie et Chirurgie Maxillo-faciale, Groupe Hospitalier Pitié Salpêtrière, 47, Bd de l'Hôpital, 75013 Paris.
Teysseres
N
N
Ragot
J P
JP
Chikhani
L
L
Favre-Dauvergne
E
E
D020083:Acquired Hyperostosis Syndrome / Q000150:complications* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D010000:Osteitis / Q000150:complications / Q000628:therapy; D010019:Osteomyelitis / Q000150:complications* / Q000628:therapy; D010027:Osteotomy; D012008:Recurrence; D012598:Sclerosis
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal