Giant Mandibular Odontogenic Keratocyst: A Case Report and Literature Review

Odontogenic keratocyst is a benign odontogenic cystic lesion whose biological behavior contrasts with its non-malignant histological nature. This lesion is known for its capacity for intraosseous extension, its local destructive potential, and its marked tendency to recur. Giant forms remain relatively uncommon and may raise genuine diagnostic and therapeutic challenges. We report the case of a 46-year-old patient who presented with a mandibular swelling evolving over six months in a context of rapidly increasing volume associated with recurrent infectious episodes. Clinical examination revealed a large mandibular swelling with cortical expansion, dental arch deformity, and submental fistulization. Imaging showed a large mandibular cystic lesion with cortical expansion and perforation, suggesting an aggressive odontogenic process. An initial biopsy performed under local anesthesia was inconclusive. The patient subsequently underwent complete enucleation with curettage under general anesthesia. Definitive histopathological examination confirmed the diagnosis of odontogenic keratocyst without evidence of malignancy. The postoperative course was marked by local infection with wound dehiscence, requiring secondary surgical management. The subsequent outcome was favorable after local debridement and close follow-up. Through this case, we discuss the clinical, radiological, and therapeutic features of large odontogenic keratocysts, as well as the importance of long-term follow-up given the high risk of recurrence.