Abstract
A 56-year-old woman with chief complaints of occlusal discomfort and jaw pain visited our dental clinic in December 2014. Bilateral temporomandibular disorder was diagnosed and treated. Her symptom of temporomandibular joint improved. However, she complained of pain in the right mandible. Computed tomography （CT） performed at Specialized medical institution indicated chronic sclerosing osteomyelitis was suspected. We were recommended a detailed examination for synovitis, acne, chronic pustulosis, hyperostosis, and osteitis （SAPHO） syndrome, and referred the patient to a university hospital Department of Rheumatology, where close inspection of the whole body was performed, and SAPHO syndrome was ruled out. Her symptoms are stable now, and we are continuing to follow up with giving dental treatment.
Discussion: When a temporomandibular disorder does not show typical findings on a medical examination, physical examination, primary care examination, or panoramic radiography, it is necessary to perform CT and magnetic resonance imaging （MRI） to arrive at a definitive diagnosis. These examinations may lead to the correct differential diagnosis or identification of comorbidities. However, when a patient is referred to a highly advanced medical institution, we should consider the subjective symptoms of the patient and visible symptom views particularly the image that even ourself did a reading shadow and talked with a specialist in image reading shadow.
Conclusions: We performed MRI and CT for a patient with chief complaints of occlusal discomfort and jaw pain at the Specialized medical institution. A detailed examination for SAPHO syndrome was performed in this case.
But the diagnosis was eventually ruled out.
