The preferred treatment for an odontogenic keratocyst is excision because it allows for complete removal of the cyst lining, which is critical to reduce the high recurrence rate associated with residual cystic epithelium. Enucleation with peripheral ostectomy is often performed to ensure complete removal of potentially infiltrative epithelial remnants. Simply observing the lesion risks progression and complications such as infection or bone destruction. Marsupialization may be used as an initial step to reduce cyst size, but definitive surgical excision provides the best long-term control. Radiation therapy is not indicated due to the benign nature of the lesion.

Reference: Oral and Maxillofacial Pathology, Neville et al, 4th Edition.