Recurrent Odontogenic Keratocyst with Delayed Follow-Up Imaging

A 24-year-old female with no significant medical history was originally scanned in 2019, when an odontogenic keratocyst was identified and an excisional biopsy was recommended. Follow-up scans submitted in 2020 and 2021 showed no evidence of recurrence. A subsequent follow-up scan in 2023 revealed some unclear findings, and the radiologist recommended additional follow-up imaging in 3 to 6 months. However, when a new scan was submitted in March 2026, 29 months had elapsed since the last radiologist-reviewed scan. The practice also requested comparison with a scan acquired in October 2024 that had not been submitted for radiologist review. Upon review of the current scan, the radiologist identified a large recurrent odontogenic keratocyst that was also present on the 2024 scan and had approximately doubled in size in the intervening period. The patient now presented with pain and swelling. The radiologist noted that the significant growth of the lesion over this period will have a substantial impact on the extent of surgery required and the patient's recovery. This case highlights the value of consistent follow-up imaging and radiologist review for lesions with known recurrence potential.