Chronic recurrent multifocal osteomyelitis is a rare autoinflammatory bone disorder of children and adolescents characterized by monofocal or multifocal inflammatory bone lesions that are culture-negative on biopsy, associated with periods of exacerbation and resolution that can last over several months to years. Although it is predominantly a disease of long bones and the spine, craniofacial involvement is not uncommon, affecting the mandible in up to one-fifth of cases. Similarities with other causes of osteitis in clinical presentation and imaging, and the lack of specific symptoms or laboratory tests, make chronic recurrent multifocal osteomyelitis mainly a diagnosis of exclusion. An accurate diagnosis is required for appropriate treatment to induce remission. This article highlights the challenges faced by plastic and oral surgeons in diagnosing mandibular chronic recurrent multifocal osteomyelitis, and describes two pediatric patients affected with the disease. Both cases were initially confused with other entities, leading to unnecessary initial treatments and a delayed diagnosis. A review aimed at surgeons summarizes the major aspects of this condition so that it is considered as a differential diagnosis in young patients presenting with a facial bony mass.
Clinical question/level of evidence: Therapeutic, V.