Cases
Case #829: 67-year-old woman with facial pain, swelling   
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Our appreciation is extended to Dr. Juan Yepes, Indiana University School of Dentistry Department of Pediatric Dentistry and Riley Hospital for Children, for contributing this case.

History: A 67-year-old woman presented to the oral surgeon with a history of six months of pain affecting the left side of her face. The patient told the surgeon that for two years she had episodes of swelling on the left side that resolved after a few days without any specific treatment.

Her past medical history was significant for hypercholesterinemia, arthritis, and hypertension. She did not report any drug allergies.

A physical exam revealed mild swelling on the left side of her face, just below the left ear, with discomfort on palpation. The intraoral exam was within normal limits.  No caries or periodontal disease was noted.

What is the most likely initial diagnosis?
Salivary gland tumor
Salivary gland infection
Odontogenic infection
Osteomyelitis