title: Diagnosis and classification of mandibular osteomyelitis.
abstract: To establish a unified classification system for mandibular osteomyelitis, various diagnostic terms were critically assessed and clinicopathologic findings of the lesions were carefully reviewed. We recommend classifying mandibular osteomyelitis into bacterial osteomyelitis and osteomyelitis associated with the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Other diagnostic terms were excluded because they were not appropriate for classification. Diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic change. The lesions are easily cured by antibiotic treatments. Mandibular osteomyelitis in SAPHO syndrome is characterized by nonsuppuration and a mixed pattern on radiography, with solid type periosteal reaction, external bone resorption, and bone enlargement. The presence of osteomyelitis in other bones, arthritis, or skin diseases (palmoplantar pustulosis, pustular psoriasis, and acne) strongly suggests this syndrome. Antibiotic therapy is usually ineffective and the symptoms of SAPHO syndrome are often persistent.
authors.affiliation: Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical Sciences, Hiroshima University Hospital, Hiroshima, Japan. suei@hiroshima-u.ac.jp
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Suei
authors.forename: Akira
authors.initials: A
authors.lastname: Taguchi
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanimoto
mesh_terms: D020083:Acquired Hyperostosis Syndrome / Q000175:diagnosis; D001424:Bacterial Infections / Q000175:diagnosis; D006801:Humans; D008336:Mandibular Diseases / Q000145:classification* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology; D010019:Osteomyelitis / Q000145:classification* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology; D011859:Radiography; D009626:Terminology as Topic