Statement of the ProblemOdontogenic keratocyst (OKC) is an epithelial developmental cyst, first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3 to 11 percent of all odontogenic cysts. The most characteristic clinical feature of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and the intrinsic growth potential following excision. Since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence.Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy’s solution, to marginal or radical resection. The recurrence rate varies from approximately 20 to 62 percent. An OKC at the angle-ramus region of the mandible has a higher tendency to recur, because of the difficulty in accessing and removing the OKC from the ramus. However, good surgical access can be obtained by sagittal splitting of the mandible, using this approach the cyst can be removed completely. We present an illustrative case of a small, lobulated OKC that involved the ramus of the mandible, and review the contemporary literature. Statement of the ProblemOdontogenic keratocyst (OKC) is an epithelial developmental cyst, first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3 to 11 percent of all odontogenic cysts. The most characteristic clinical feature of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and the intrinsic growth potential following excision. Since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence.Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy’s solution, to marginal or radical resection. The recurrence rate varies from approximately 20 to 62 percent. An OKC at the angle-ramus region of the mandible has a higher tendency to recur, because of the difficulty in accessing and removing the OKC from the ramus. However, good surgical access can be obtained by sagittal splitting of the mandible, using this approach the cyst can be removed completely. We present an illustrative case of a small, lobulated OKC that involved the ramus of the mandible, and review the contemporary literature. Odontogenic keratocyst (OKC) is an epithelial developmental cyst, first described by Phillipsen in 1956. The frequency of OKC has been reported to vary from 3 to 11 percent of all odontogenic cysts. The most characteristic clinical feature of OKC is the high frequency of recurrence. The mechanism of recurrence is thought to be related to residues of cyst epithelium and the intrinsic growth potential following excision. Since the lining of the OKC is thin and friable, removal of the cyst in one piece may sometimes be difficult. Complete removal of the cyst lining without leaving behind remnants attached to the soft tissue or bone is necessary to avoid recurrence. Therapeutic approaches vary in different studies from marsupialization and enucleation, which may be combined with adjuvant therapy such as cryotherapy or Carnoy’s solution, to marginal or radical resection. The recurrence rate varies from approximately 20 to 62 percent. An OKC at the angle-ramus region of the mandible has a higher tendency to recur, because of the difficulty in accessing and removing the OKC from the ramus. However, good surgical access can be obtained by sagittal splitting of the mandible, using this approach the cyst can be removed completely. We present an illustrative case of a small, lobulated OKC that involved the ramus of the mandible, and review the contemporary literature.