Ameloblastoma is an aggressive benign tumor of epithelial origin which may arise from epithelial elements that are part of the tooth-forming apparatus. It is the most common neoplasm affecting the jaws, yet only accounts for 1% of all tumors of the maxilla and mandible and 11% of all odontogenic tumors. The mandibular area mainly affected by this neoplasm is the molar-ramus area, with a variable incidence ranging from 80% to 99%.
This presents a case of an ameloblastoma mistake for a squamous cell carcinoma on tissue biopsy. Wide excision of the mass with fibular myocutaneous free flap reconstruction was supposed to be done but due to inadequate blood flow to the peroneal vessels, the pectoralis major myocutaneous flap with rib was used instead. Titanium plates and screws were used to fix the rib. On follow-up radiographic examination of the chest, a screw was seen at the level between the right 4th and 5th ribs. Repeat panoramic X-ray of the mandible was done and compared with the previous plates. One screw was missing from the new plate.