Aims: To report a case of massive ameloblastoma in mandible with wide excision and reconstruction with free vascularized fibular graft and titanium plate. Case Description: A 49- year-old male patient complained right facial mass since 5 years ago. Patient underwent right hemimandibulectomy with general anesthesia and pathologic examination revealed folliculare ameloblastoma. The large defect after resection reconstructed with free fibular graft. Fibula was osteotomised and resembled with mandible shape and reconstructed by plate with intact pedicle. Care was taken to protect the periosteal branch of the peroneal artery before performing an osteotomy. Shaping of the resected fibula was done according to the preoperative template. A titanium miniplate with locking screws was used to secure the osteotomized fibula and the mandible. To secure the airway, we performed tracheostomy. Followup after operation, patient still got a defect facial asymmetry in right mandible. Discussion: Ameloblastoma is histologically benign but locally aggressive tumor originating from odontogenic epithelium. After hemimandibulectomy, reconstruction continued with microvascular free fibular graft and titanium plate. Osteotomies were performed with the pedicle still attached. Conclusions: Free vascularized fibular graft with titanium plate is preferrably reconstruction option for large defect after wide excision of mandibular ameloblastoma.

Introduction and importance Anterior chest wall Giant Basal Cell Carcinoma (GBCC) is rare amongst GBCC cases and results in a large defect that is challenging to resect and reconstruct. It requires multidisciplinary approach to prevent recurrence. Case presentation A 72-year-old man with giant basal cell carcinoma at the anterior chest wall measuring 10 × 6 cm. Wide resection of 1 cm margin with axial flap was performed to close the defect. The follow-up report stated that the patient was satisfied with the result and there was no recurrence observed. Clinical discussion Review of literatures concludes that GBCC is excised with a minimum of 4-6 mm margin outside the tumor area. The axial IMAP flap is ideal to close the upper chest wall defect because of the better aesthetic outcome compared to other conventional flaps, especially in stable elderly male, patients with noninfected wound. Increased skin laxity and more relaxed skin tension associated with aging allows easier tissue mobilization and transfer to close the defect. Conclusion Axial flap for GBCC in anterior chest wall is ideal, safe, and has the advantage of aesthetic reasons of suitable skin tone, particularly for stable elderly male patients.