Periapical Cysts Exhibit Multilocular Characteristics Similar to Odontogenic Keratocysts and Ameloblastomas

The clinical imaging typically presents as a multicystic lesion in the jawbone, which is mostly diagnosed as ameloblastoma, myxoma, or odontogenic keratocyst. Preoperative biopsy is often challenging due to the intraosseous location of these lesions. Consequently, clinicians frequently rely on these characteristic multicystic imaging features to diagnose either ameloblastoma or odontogenic keratocyst, subsequently planning treatments ranging from marginal resection to mandibular segmental osteotomies with concurrent autogenous bone grafting. However, we encountered two cases of multicystic lesions in the jawbone with a pathological diagnosis of periapical cyst. The treatment for periapical cyst typically involves only curettage of the periapical lesion, eliminating the necessity for bone resection or grafting procedures. In most cases, tooth extraction is also unnecessary. Therefore, compared with the management of ameloblastomas and odontogenic keratocysts, periapical cyst treatment results in significantly less irreversible damage and patient discomfort. This study reports 2 rare cases of multicystic periapical cysts with detailed clinical, imaging, and pathological analyses. Through these cases, we aim to enhance clinicians' awareness of the possibility that multicystic jaw lesions with multilocular radiographic features could represent periapical cysts. When necessary, a biopsy should be performed to determine the pathological type before formulating a treatment plan.