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A previously well 10-year-old girl presented to the hospital on three occasions over a 2-week period with worsening right-sided cheek swelling and pain. Examination was unremarkable apart from obvious swelling of the right cheek and cervical lymphadenopathy (figure 1). An initial diagnosis of suppurative parotitis was made, and she was treated with oral flucloxacillin. Over the following week, pain and swelling worsened, and she developed fever, nausea, trismus and dizziness.