Background: The odontogenic keratocyst (OKC), earlier referred as the keratocystic odontogenic tumor, is a distinctive form of developmental odontogenic cyst. OKC is unique because of its distinguishing clinical features, including potentially aggressive behavior, high recurrence rate and an association with the nevoid basal cell carcinoma syndrome. Treatment options includes from conservative approach to extensive surgeries including marsupialization, enucleation or segmental resection. We hereby report a case of a massive OKC of mandible, which was treated conservatively with outstanding results.

Methodology: A 27 year old male patient presented with the complaint of swelling of the lower jaw since one year. His past history revealed trauma to the lower jaw due to self fall 15 years ago. Examination revealed a single, well-defined, irregular swelling seen over the lower jaw extending from one angle to the other with both buccal and lingual cortical plate expansion along with egg shell crackling. Radiographical examination revealed unilocular radiolucency extending from one angle to the other with a paper thin lower border. On histopathological examination it was diagnosed as odontogenic keratocyst. The patient was managed with enucleation under local anaesthesia followed up by iodoform dressing every week and Carnoy’s solution application every alternate week.

Results: On regular follow up of one year, significant improvement and formation of healthy bone with respect to the cortical plates and floor of the defect was noted.

Conclusion: Conservative management with meticulous regular follow ups can successfully manage a massively extensive OKC with overwhelmingly miraculous results.