Facial swelling is a common problem in the pediatric population with a variety of causes, ranging from congenital to acquired diseases. A fundamental understanding of typical clinical presentation helps in narrowing this broad differential.

A 35-month-old, previously healthy, African American boy presented with 2 weeks of intermittent nightly leg pain and 1 week of unilateral, progressive nontender facial swelling. He had severe, achy right leg pain relieved by ibuprofen, which was diagnosed as a sprain at an outside emergency center 2 days before admission. The patient had developed mild, nontender right facial swelling 1 week before admission and had started amoxicillin for a suspected tooth abscess (Fig 1). He developed a fever of 38.7°C 2 days before admission. Because the patient failed to improve with outpatient management, he was admitted for further evaluation.

On admission, the patient appeared well nourished with mild fever of 38.1°C, pulse rate of...

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