The dilemma of management of cystic lesions; an uncertain way forward: a case report Authors Fahad Umer Department of Operative Dentistry and Endodontics, Aga Khan University Hospital, Karachi, Pakistan Niha Adnan Department of Operative Dentistry and Endodontics, Aga Khan University Hospital, Karachi, Pakistan Madiha Khan Department of Operative Dentistry and Endodontics, Aga Khan University Hospital, Karachi, Pakistan Madiha Bilal Qureshi Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan DOI: https://doi.org/10.47391/JPMA.8601 Keywords: Granuloma, periradicular lesion, apical cyst, periapical surgery, non-surgical retreatment Abstract Periapical diseases ranges from mild granulomatous lesions to large cystic ones, with the treatments corresponding to their respective pre-operative diagnoses. However, the determination of cause of periapical radiolucency is impossible on pre-operative clinical and radiographic examinations. We present a case highlighting the difficulties encountered in treating a periapical cyst using the current evidence in literature. It demonstrates the uncertainty involved in treating such lesions, owing to the impossible nature of determining the histopathological nature of the cyst, i.e., being either true cysts or pocket cysts. This case includes orthograde re-treatment; decompression of the cystic lesion, followed by peri-apical surgery of two teeth over a course of three years; and the uncertain outcomes encountered after each phase of the treatment. Keywords: Granuloma, periradicular lesion, apical cyst, periapical surgery, non-surgical retreatment. Downloads Full Text Article Published 2023-10-30 How to Cite Umer, F., Adnan, N., Khan, M., & Qureshi, M. B. (2023). The dilemma of management of cystic lesions; an uncertain way forward: a case report. Journal of the Pakistan Medical Association, 73(11), 2269–2272. https://doi.org/10.47391/JPMA.8601 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 73 No. 11 (2023): NOVEMBER Section Case Report License Copyright (c) 2023 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.