When Occam's razor loses its edge: the simplest explanation isn't always correct

Abstract

Dental infections are common in children. Occam's razor, typically paraphrased, suggests that the simplest solution is most likely the right one. We report a case of an 11-year-old child who presented with right-sided facial swelling, fever, trismus, and a heavily broken-down right maxillary molar with a large apical radiolucency. After admitting the child, intravenous antibiotics and fluids were prescribed in preparation for the extraction of the UR6 and LR6 in theatre early the next morning. However, 9 hours later, before surgery, the patient unexpectedly and rapidly deteriorated neurologically. MRI and CT examination revealed a diagnosis of a subdural empyema. This emergency was managed with a multidisciplinary team, involving neurosurgeons, oral and maxillofacial surgeons, otolaryngologists, and radiologists. The case highlights the importance of not assuming that the simplest diagnosis is always the only, or most appropriate, one to make. CPD/Clinical Relevance: Regarding patients with a facial swelling, high order thinking may be required in clinical diagnosis.