Aggressive Osteomyelitis of the Jaw Masquerading as Adenoid Cystic Carcinoma

Aggressive osteomyelitis of the jaw presents with a destructive pattern, including bone necrosis, pain, and swelling, which can sometimes make it difficult to differentiate from malignancy. This article reports a case of a 47-year-old female patient diagnosed with aggressive osteomyelitis that was initially confused with adenoid cystic carcinoma (ACC). ACC is a rare salivary gland tumor that grows slowly but can involve perineural invasion and distant metastasis. In this patient, the clinically reported pain and radiologic findings suggested perineural invasion and skip metastasis, leading to suspicion of ACC. However, intraoperative findings and pathologic evaluation confirmed a diagnosis of chronic osteomyelitis. Through this case review, the authors aim to suggest to surgeons that osteomyelitis be considered as a differential diagnosis for ACC and to highlight the possibility that clinical and radiologic findings may differ from pathologic results.