Introduction Paediatric facial trauma without visible signs can mask serious issues like chronic infections and retained foreign bodies. We present a case highlighting the complexities of diagnosing occult injuries and the critical role of imaging in diagnosis and intraoperative management A 4-year-old boy fell into a flower bed in March 2024, with no external wounds or skin breaks. He developed facial swelling over the zygomatic ridge and was admitted under Paediatric ENT with a suspected infected hematoma, treated with Augmentin, and discharged. Recurring infections in April and May led to intermittent hemifacial swelling managed by a GP with antibiotics By July, the patient re-presented with left periorbital swelling, prompting an ENT referral. An August CT and MRI showed chronic osteomyelitis of the left zygoma and zygomatic arch, extensive inflammation in the temporal and infratemporal fossae, and two non-enhancing areas suggesting possible retained foreign bodies In September, surgery was performed to remove foreign bodies and biopsy bone. Multiple foreign bodies were extracted from the left temporal fossa and orbital rim, with findings of chronic inflammation and periosteitis. The injury trajectory suggested an intraoral entry with migration to the infratemporal fossa. Intraoperative ultrasound enabled successful foreign body extraction, and infection control was managed with a 6-week antibiotic course with Infectious Diseases Discussion This case emphasizes the challenges in diagnosing occult paediatric injuries, the risk of retained foreign bodies, and the importance of advanced imaging for precise diagnosis and intraoperative guidance. It underscores a multidisciplinary approach and vigilance in seemingly minor paediatric trauma cases to avoid long-term complications Conclusion Comprehensive imaging and surgical exploration are essential in managing chronic infections and foreign bodies in paediatric facial trauma cases, especially when initial presentations appear mild but symptoms persist