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A man in his early 50s presented to his dentist with left-sided facial pain and swelling. The dentist did not identify any oral health problems. Symptoms persisted and he saw his general practitioner (GP) who prescribed amoxicillin to cover for infection. Despite antibiotics, the condition worsened, leading the patient to attend the emergency department (ED). At the ED, he reported no fever and his temperature and serum inflammatory markers were normal ( table 1).