DOI: https://doi.org/10.36347/sjmcr.2025.v13i10.074

Pages: 2497-2501

Background: Odontogenic keratocyst (OKC) is a developmental cyst from dental lamina or basal epithelial rests, marked by locally aggressive, anteroposterior intraosseous expansion and a meaningful recurrence risk; in the 2022 WHO framework it remains classified as a cyst distinct from the orthokeratinized variant, warranting histopathologic confirmation and subclassification for risk stratification. Case presentation: An incidental mandibular radiolucency was identified in an asymptomatic patient without extraoral swelling; examination noted slight vestibular cortical deformation and non‑vital 33–32 managed by endodontic therapy prior to surgery. CBCT confirmed a well‑circumscribed symphyseal lesion; intraoperatively a thin, friable cystic wall with pasty keratin‑like content was found, and histopathology confirmed OKC. Outcome: Enucleation via a buccal approach with double osseous trepanation provided complete access and meticulous curettage. Postoperative recovery was uneventful, with satisfactory mucosal healing at 14 days and no early signs of recurrence on short‑term follow‑up. Discussion: Management spans conservative to aggressive options. Meticulous primary enucleation is standard; adjuncts such as Carnoy’s solution or peripheral ostectomy may lower recurrence, while marsupialization/decompression can downsize large lesions before definitive surgery; resection is reserved for recurrent/aggressive disease. Recurrences cluster within five years, often due to residual lining, satellite cysts, or new primaries; multifocal/recurrent cases merit evaluation for Gorlin–Goltz syndrome. Conclusion: A conservative, anatomy‑preserving strategy achieved lesion eradication, reduced recurrence risk through optimized access and thorough curettage, and maintained mandibular continuity and function, supporting structured long‑term clinical and radiologic surveillance.