What is the preferred approach to treating a cystic lesion that is significantly large or recurrent?

The preferred approach to treating a significantly large or recurrent cystic lesion is aggressive curettage. This method involves the surgical removal of the cyst lining and contents, which helps to address both the immediate lesion and reduce the risk of recurrence.

Aggressive curettage is particularly effective in cases where the cyst is large or has a tendency to recur because it allows for a more thorough excision and minimizes the chance of residual disease being left behind. By excising the cyst completely, the likelihood of subsequent growth is considerably reduced, making it a primary choice in management.

While observation may be suitable for smaller or asymptomatic lesions, it is not effective for larger or recurrent cases that pose a higher risk of complications. Needle aspiration can provide temporary relief or diagnostic information but does not adequately address the underlying pathology, making it an insufficient treatment for larger or problematic cysts. Bone grafting might be necessary following a surgical approach to restore bone volume after extensive lesion removal, but it does not serve as a primary treatment for a cyst itself.

Therefore, aggressive curettage stands out as the most effective and definitive option for managing large or recurrent cystic lesions.