It is relatively common to observe a solitary well defined periapical cystic change associated with decayed primary tooth displacing the underlying developing permanent tooth bud. Marsupialisation of such cysts is indicated so as to allow for eruption of the underlying tooth bud. A similar solitary well defined periapical cystic lesion involving the mixed dentition in a child was planned for enucleation. Surprisingly, during the surgical intervention two distinct separate cystic pathological changes were observed. Marsupialisation of the cystic defect with extraction of the primary tooth would have left the enlarged follicle with the developing tooth bud unaddressed. The pathological process associated with the dilated follicle would continue to progress further and may require an additional surgical intervention. The distinction between enlarged follicle and dentigerous cyst clinically is also important. Considering the size, extent and presence of the large bony cavity during the surgical intervention enucleation of both the pathological changes was performed.