Tuberculosis is typically a pulmonary chronic infectious disease with a high prevalence in developing countries which carries a substantial rate of mortality. Extrapulmonary disease may occur, mainly second to the endogenous spread of the pathogen from the primary site. Oral or mandibular involvement represents a minority among the reported cases. A 12-year-old female patient with a diffuse left-sided facial swelling and dull pain that gradually developed over 8 months, presented to us with misdiagnosis and poor management. Examination was found to have a firm swelling involving the buccal region, and left posterior mandible with intact overlying skin and mucosa, and palpable cervical lymphadenopathy. Imaging showed a heterogeneous osteolytic lesion of left ramus extending to the surrounding soft tissue. The diagnosis with oro-facial tuberculosis was established by histopathological study and confirmed by the Mantoux test and polymerase chain reaction. Although it occurs rarely, oro-facial tuberculosis has detrimental local and systemic effects, and devoid of characteristic clinical and radiographic features, poses a diagnostic challenge.