A cyst following implantation of respiratory epithelium during surgical procedures has been documented only rarely. A variety of names have been attached to this lesion: respiratory mucocele, respiratory implantation cyst, surgical ciliated cyst, and surgical (implantation) cyst. In seven prior case reports, the interval between the initiating surgical procedure and diagnostic biopsy of the resultant well-circumscribed radiolucency and histopathological demonstration of distinctive pseudostratified ciliated columnar epithelial lining has varied from 4 to 40 years. In the case reported here, chin augmentation used "residual maxillary bone" as the donor tissue and likely transplanted sinonasal mucosa into the mandible during orthognathic surgery, resulting in a painful anterior mandibular cyst lined by respiratory epithelium that was ablated 16 years later.