Purpose or Case Report: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder primarily affecting children and adolescents. While CRMO typically involves the metaphyses of long bones, facial involvement, particularly of the mandible, represents an important but less recognized manifestation. This pictorial review aims to illustrate the imaging findings of facial involvement in CRMO across various modalities, including conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine studies. We present characteristic imaging patterns, discuss the evolution of imaging findings throughout the disease course, and provide guidance on differentiating CRMO from mimicking conditions. Radiographically, mandibular CRMO typically presents with expansion, mixed lytic and sclerotic changes, and periosteal reaction. CT demonstrates the characteristic “bone-on-bone” appearance with cortical perforation, while MRI shows bone marrow edema with T2/STIR hyperintensity and adjacent soft tissue inflammation. Nuclear medicine studies reveal increased uptake in affected areas with relatively subtle blood pool phase activity. Recognition of these imaging patterns is crucial for early diagnosis, appropriate management, and monitoring of treatment response in patients with facial CRMO.
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