The term paradental cysts (PC) was first introduced by Craig in 1976 and is described as "A cyst of uncertain origin found primarily on the distal or facial aspect of a vital mandibular third molar, consisting of intensely inflamed connective tissue and epithelial lining." It is included in the group of rare lesions constituting 1-5% of all odontogenic cysts. PC is often associated with mandibular third molars and less frequently, with the second and first molars and rarely with premolars or canines/incisors. Not many cases of PC have been reported in maxillary teeth. The PC has been misdiagnosed as dentigerous cyst, lateral radicular cyst, pericoronal abscess, or some other entity related to the inflammatory conditions of the dental follicle. Lesions like dentigerous cyst may transform to an ameloblastoma, squamous cell carcinoma, or mucoepidermoid carcinoma which requires moderate to extensive surgical interventions with varied prognosis. Lateral radicular cyst and pericoronal abscess require minimal intervention. On the other hand, the topography, behavior, and clinical management are different with a better prognosis for PC. Therefore, it is important to diagnose PC by correlating the radiographic and histologic findings from other entities.

Adenoid cystic carcinoma (ACC) is an uncommon malignant tumor of the salivary glands. It generally involves the minor salivary glands, and the hard palate is the most common site. ACC presents as a slow growing mass with mild pain and usually demonstrates perinueral invasion. An intraosseous occurrence of ACC is a very rare and when it occurs the mandible is more commonly involved than the maxilla. A Pubmed search has revealed only 26 case reports of intraosseous ACC involving the mandible until date. Hence, reporting one such rare case of intraosseous ACC in a 49-year-old male patient involving the mandible.