Histopathological Analysis of Asymptomatic Huge Radicular Cyst: Contributory Factors and Unique Feature for an Adult Libyan Patient

Background: Radicular cysts are the most prevalent odontogenic cystic lesions of the jaws, typically arising from epithelial remnants in periapical granulomas following pulpal necrosis. While usually asymptomatic and small, they can occasionally attain considerable dimensions, presenting diagnostic and therapeutic challenges. This report details the management of a massive, asymptomatic radicular cyst in a young adult, emphasizing the critical role of advanced imaging and a multidisciplinary approach. Case Presentation: A 22-year-old Libyan male presented with a 6-month history of a painless, progressively enlarging swelling in the left anterior maxilla. Clinical examination revealed a significant palatal swelling extending from teeth #22 to #25. Cone-beam computed tomography (CBCT) imaging delineated a well-defined, corticated unilocular radiolucency measuring approximately 3.5 x 2.8 cm, causing substantial palatal bone erosion. The involved teeth (#22, #23, #24) were non-vital. The treatment plan comprised preoperative endodontic therapy on the involved teeth, followed by CBCT-guided surgical enucleation via a full-thickness mucoperiosteal flap. Histopathological analysis confirmed the diagnosis of a radicular cyst, showing a lining of non-keratinized stratified squamous epithelium with a dense, chronically inflamed fibrous capsule. Conclusion: This case underscores that radicular cysts, though common, can present with extensive bony destruction without classic symptoms. It highlights the indispensable utility of CBCT for accurately assessing lesion extent and anatomical relationships preoperatively. A combined endodontic-surgical strategy ensured complete removal of the pathologic tissue while preserving the involved teeth and surrounding structures, resulting in successful rehabilitation and patient satisfaction. Long-term follow-up is essential to monitor healing and ensure the absence of recurrence.