Pathological fractures of the facial bones are relatively rare. Four pathological mandibular fractures are presented and the difficulty in diagnosing the underlying cause and the dilemma of treatment choice are discussed with a review of the literature. The authors found the incidence of pathological fractures of the facial bones in their series was 0.47%. Biopsy followed by rigid internal fixation, preferably with an AO reconstruction plate bridging the area of pathology after its removal, permits normal function and allows good and undisturbed healing which will inevitably be prolonged in such cases.