Odontogenic keratocyst now officially known as keratocystic odontogenic tumuor, treatment has been part of numerous discussions over the years. Based on a literature review, more aggressive treatment like resection or enucleation supplemented with carnoy’s solution with or without peripheral ostectomy results in a lower recurrence rate. However, reported recurrence rate after marsupilization followed by enucleation is not significantly higher than that after aggressive modalities. We are presenting a case series of 21 patients (27 KCOT’S) of size varying from 2 to 15 cm (average of 10 cm) anteroposteriorly treated by various modalities at our center. Long term follow up results shows 29% recurrence, all of them recurring within first two years which is consistent with published data. We want to stress upon the fact that histology, age of patient and extent play an important role in deciding final treatment modality. Although the future treatment may involve molecular based modalities and hence eliminate need for aggressive surgical management but as of now in our experience most effective treatment are enucleation supplemented with carnoy’s solution or marsupilization with later cystectomy and more ablative surgery in rare cases. All these possibilities will be discussed in the presentation for best possible treatment for complex pathology like odontogenic keratocysts.