The primary chronic aseptic osteomyelitis is a rare form of bone infection but treatment is sometimes very difficult. The aim of this presentation is to demonstrate clinical symptoms, clinical course and different strategies for treatment in a case of severe manifestation in the mandible.The female patient was 13 years old when a chronic recurrent osteomyelitis of the mandible was diagnosed in 1993. After histologic verification multiple treatments followed: decortication combined with administration of antibiotics, rheologics, antiphlogistics, and analgetics, microwave and jodiontophoresis as well as hyperbaric oxygenation. None of this concepts led to improvement, however, a massive increase of volume of the mandible could be assessed on both sides. This esthetic impairment as well as the unchanged clinical symptoms led to psychological changes of the young patient, which made an additional psychotherapy necessary. With a new concept with a combination of azithromycin and calcitonin only little improvement could be achieved. At the moment the patient is in stable somatic and psychologic conditions and presses for a osteoplasty to remodel the whole contour of the mandible to improve the appearence temporaryly. Keywords: diffus sklerosierende Osteomyelitis, Unterkiefer, Therapieoptionen, klinischer Verlauf