A case of a hand origin addresses the question of the pathogenesis of odontogenic tumors. The inflammatory genesis of smaller follicular cysts is considered possible. However, this is insufficient to explain abnormally large cysts with heterotopic tooth retention, especially when these cyst formations occur multiple times in the same individual and in conjunction with other malformations. For these cases, the formation as a malformation of a tooth germ or the dental lamina is much more likely, and it would therefore be more accurate to classify this particular cyst form as odontogenic tumors. The X-ray image always allows for the general diagnosis: odontogenic tumor. The precise differentiation of the tumor is only possible through histological examination, except in the case of an odontoma. Since a mutilating operation is required in the case of an adamantinoma, the diagnosis must be made in every unclear case.