title: Mandibular osteomyelitis in children mimicking juvenile recurrent parotitis.
abstract: OBJECTIVE
  To describe pediatric cases with mandibular osteomyelitis initially diagnosed and treated as juvenile recurrent parotitis.
  
  
  METHODS
  We reviewed the patient data of all our pediatric patients treated at Helsinki University Central Hospital, a tertiary care hospital, between 1998 and 2010 who had the initial diagnosis of recurrent parotitis which in fact was osteomyelitis.
  
  
  RESULTS
  Over a period of 12 years, six children (aged 5-17 years, five girls) presented with mandibular osteomyelitis primarily diagnosed as recurrent parotitis. Diagnostic delay ranged from 1.5 months to 6.0 years before the final diagnosis of mandibular osteomyelitis confirmed in MRI. Of the six cases undergoing biopsies, bacterial culture showed Actinomyces or Streptococcus viridans in four cases. All patients received antimicrobial treatment. Two received hyperbaric oxygen therapy with no resolution of symptoms. Debridement was performed in these two cases as well, and in the second case persistent symptoms led to bisphosphonate treatment.
  
  
  CONCLUSIONS
  Juvenile parotitis is in most cases a clinical diagnosis, and treatment is symptomatic. In contrast, mandibular osteomyelitis is a severe disease requiring lengthy treatment. Because symptoms of these two entities may mimic each other, unclear cases require MRI.
authors.affiliation: Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland. riitta.t.saarinen@hus.fi
authors.forename: Riitta T
authors.initials: RT
authors.lastname: Saarinen
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
authors.forename: Risto
authors.initials: R
authors.lastname: Kontio
authors.forename: Riste
authors.initials: R
authors.lastname: Saat
authors.forename: Eeva
authors.initials: E
authors.lastname: Salo
authors.forename: Anne
authors.initials: A
authors.lastname: Pitkäranta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010309:Parotitis / Q000175:diagnosis*; D012008:Recurrence; D012189:Retrospective Studies