INTRODUCTIONThe mandible is a physiologically complex bone and is analogous to long bone. More than 30 lesions, including benign and malignant tumours, frequently occur in the mandible. In the spectrum of pathologies that present in the posterior mandible, ameloblastoma shows a marked prevalence. A variety of non-odontogenic solid malignancies can also occur in the mandible, but the mandible is not usually the primary site of diagnosis, rather it is known for metastatic involvement1.Small cell neuroendocrine carcinomas (SNECs) are poorly differentiated high-grade neuroendocrine tumours that usually present as primary lung tumours near the bronchial region. Head and neck events are infrequent, with the larynx being the most prevalent site. SNEC is diagnosed based on histology and confirmation of origin by immune histochemistry2. Primary SNECs in the head and neck region are sporadic tumours, with only a few cases reported in the English literature.This case report describes a primary SNEC diagnosed in the mandibular ramus of an elderly female patient who presented to the department with a swelling over the posterior mandible. The clinical presentation, and imaging findings initially were consistent with that of the benign odontogenic tumour, Ameloblastoma, until the immunohistochemistry reports were received.