Abstract
We present a 10-year old boy with recurrent swelling of the right mandibular region. Based on the diagnosis of chronic recurrent parotitis, he received only supportive treatment. Because of frequent relapses, the diagnosis was reconsidered. Magnetic resonance imaging, scintigraphy and biopsy were compatible with chronic osteomyelitis. This lead to a diagnosis of mandibular primary chronic osteomyelitis, an uncommon non-suppurative inflammatory disease of unknown origin. After decortication of the mandible, the patient recovered well. Because there were no further complaints, the follow-up was ended 18 months after the operation.
Highlights
We report a case of a ten-year-old boy who presented with recurrent unilateral swelling of the right jaw
When he presented at the outpatient clinic, swelling and pain of the right jaw region had been present for one month (Figure 1)
As not all examinations were compatible with parotitis, and as there was no explanation for the fact that the boy was unable to fully open his mouth, a new magnetic resonance imaging (MRI) of the jaw was performed
Summary
This case report illustrates the difficulties encountered during diagnosing a child with recurrent swelling in the jaw region. In the presented case an auto-inflammatory disease (chronic recurrent multifocal osteomyelitis), autoimmune, obstructive or chronic recurrent parotitis, as well as (non-) ossifying fibroma, fibrous dysplasia, lymphadenitis or secondary lymphadenopathy due to malignancy such as osteosarcoma were considered. The location of the symptoms and the positive impact of sialography were concomitant with the diagnosis of chronic recurrent parotitis, but the presence of atypical findings (normal values of serum amylase, long duration of the symptoms and difficulty in opening the mouth) made us doubt the earlier diagnosis
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