Abstract :A 27 year old woman presented to her dentist with a complaint of pain and swelling in the right retromolar area. She was referred to a local periodontist. Her symptoms persisted after extraction of tooth #32, which was believed to be the source, and subsequently failed to subside after repeated debridements and multiple courses of antibiotic therapy. The patient was referred to an oral and maxillofacial surgeon who performed a biopsy with a resultant diagnosis of an intermediate grade mucoepidermoid carcinoma. Definitive treatment consisted of a composite resection of the mandible with selective neck dissection and adjuvant radiation therapy. This case underscores the importance of recognition of the failure of a disease process to respond to standard treatment modalities and the necessity for timely referral or alteration of therapeutic course.