Lesions above and below palate: dual pathologies appearing as single lesion

Both fungal sinusitis and radicular cysts are relatively common conditions; however, their simultaneous occurrence can pose diagnostic and therapeutic challenges, particularly when a radicular cyst is in the upper alveolus. We report a patient with a palatal radicular cyst associated with carious maxillary teeth, presenting mainly with cosmetic deformity. CT demonstrated a well-defined cystic lesion extending into the palate and anterior maxillary wall, along with heterogeneous opacification of the left maxillary sinus consistent with fungal involvement. This coexistence raised important considerations regarding surgical sequencing and the feasibility of a combined approach. The patient underwent a single-stage procedure comprising complete cyst excision, endoscopic middle meatal antrostomy and extraction of all non-restorable teeth. This case highlights the diagnostic challenges, radiological interpretation and operative decision-making required in managing this rare dual pathology.