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Osteomyelitis is mainly caused by pyogenic organisms that spread through fractures, the bloodstream, or surgeries. It is a serious bone infection that can be either acute or chronic. It involves an inflammatory process affecting the bone and its surrounding structures. Management of osteomyelitis mainly depends on the nature of the lesion. In pathological fracture, the usual treatment is resection of the lesion with affected margins. However, the reconstruction is usually delayed until the infected bone is completely removed. In this case report, we demonstrate a case of an unusual presentation of osteomyelitis in the right body of the mandible which caused a pathological fracture following the extraction of the lower right first molar. The patient was further treated by segmental resection, coronoidectomy, and reconstruction of the defective site using a recon plate with inferior alveolar nerve preservation using the lateralization technique., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fatani et al.)