Introduction: The Odontogenic Keratocyst (OKC) presents a unique challenge in the dentistry and oral pathology area. This locally aggressive lesion has been a matter of discussion in the literature, with debates revolving around its classification as either a cyst or a tumor. Its prominence as the third most common cyst in the jaw bones has captured the attention of clinicians and researchers alike. Given its aggressive clinical behavior and high recurrence rate, various treatment methods have been proposed to address OKC and mitigate the risk of recurrence, yet the ideal treatment approach and surgical margins remain elusive.

Case Report: This case report highlights the management of a large circumscribed OKC and underscores the importance of long-term patient follow up. The patient has undergone five years of vigilant monitoring without any signs of recurrence. Ultimately, this case highlights the significance of adopting a personalized treatment approach that considers the patient’s specific needs and lesion characteristics.

Conclusion: By prioritizing patient-centered and lesion-oriented decision-making, this case offers valuable insights for clinicians and serves as a reference for future similar cases.