Radiographic evaluation of possible etiology of diffuse sclerosing osteomyelitis of the mandible.

To examine the cause and site of origin of diffuse sclerosing osteomyelitis of the mandible, we compared various radiographic findings for the mandibular lesions in 20 patients with diffuse sclerosing osteomyelitis with those in 48 patients with osteomyelitis caused by bacterial infection. In osteomyelitis of infectious origin, a typical radiographic feature was a radiolucent lesion spreading in the cancellous bone, with cortical bone perforation and lamellated periosteal reaction. In diffuse sclerosing osteomyelitis, intermingled sclerotic and osteolytic lesions with solid periosteal reaction or external bone resorption were a common finding, and in some patients the cortical bone was initially affected by the fresh or recurrent lesion. Based on these distinct differences, we suggest that the cause of diffuse sclerosing osteomyelitis is not bacterial infection and that the site of origin is not in the bone but in the periosteum.