Objective:The purpose of this study was to report our experiences of thirty-five patients with mandibular odontogenic keratocyst(OKC)treated by radical resection over a 12-year period.Methods:A retrospective review of patients with OKC treated from 2003 to 2015 was carried out.Five hundred sixty-five patients were identified,of which 35 patients underwent segmental or marginal mandibulectomy.Radical resection plan was based on clinical and/or radiographic evidence of size,cortical perforation and subsequent soft tissue involvement,and history of the previous recurrence of the same lesion.Results:There were 26 OKCs in the mandibular molar-ramus,8 in the mandibular anterior-premolar region,and 1 in the mandibular molar-ramus and anterior-molar.Twenty patients had primary OKCs and fifteen had recurrent OKCs.Segmental mandibulectomy was completed in 31 patients and 28 patients were immediately reconstructed with vascularized flap.Marginal mandibulectomy was performed in 4 patients.Functional and cosmetic outcomes of patients were satisfactory.Recurrence was found in one patient treated for marginal mandibulectomy.Conclusion:Radical resection is indicated for extensive OKC with locally aggressive features.Due to the high morbidity related to radical resection,immediate mandibular reconstruction with vascularized flap plays a key part in such treatment modality with decreasing the morbidity associated.