The recalcitrant keratocyst

The clinical enigma of appropriate management of the odontogenic keratocyst is a continuing controversy. The understanding of the pathology of the lesion has undergone a significant metamorphosis over the past 30 years. Certain research findings with respect to this lesion have set it apart from the classical odontogenic cyst, while histologic and clinical observations have made its behaviour reminiscent of the ameloblastoma. Despite its benign nature, its high recurrence rate begs the question of adequacy of treatment modalities to date. Fascinating theories have been put forward to account for its apparent resistance to conventional cyst therapy. Despite this, however, there is no unanimity as to pathogenesis or correct treatment methods. The case of a large odontogenic keratocyst of the mandible is reported and a detailed narrative of its apparently successful management by relatively conservative means is documented.