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Aim <p>Odontogenic keratocyst (OKC) is aggressive cyst with high recurrence rates, traditionally treated using Carnoy’s solution (CS) as an adjunct to surgical enucleation. However, the toxicity and potential complications of CS, including neurotoxicity and tissue damage, necessitate the exploration of safer alternatives. The aim of systematic review was to evaluate potential alternatives to CS for preventing recurrence and minimizing postoperative complications in OKC.</p> Methods <p>Studies were searched and retrieved from PubMed, Scopus, and Web of Science using relevant keywords. Inclusion criteria focused on studies evaluating alternatives to CS for OKC treatment, while reviews, case reports, and non-clinical studies were excluded. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2 Tool. Data extraction included study design, intervention, recurrence rates, and complications. Findings were summarized descriptively. Meta-analysis (random-effect model) was performed for recurrence in OKC.</p> Results <p>Six studies met the inclusion criteria after examining 280 studies. These studies examined recurrence and post-operative complications in CS, modified CS (MCS), and 5- Fluorouracil (5-FU) treated OKC cases. The recurrence events were 15/153 with CS and 37/200 with MCS; however, no recurrence was recorded for 5-FU. Paresthesia was seen in 17/74 of OKC-treated CS/MCS cases and 12/72 of OKC-treated 5-FU cases after surgery. The random-effects model estimated a pooled risk ratio of 0.13 (95% CI: 0.02 to 0.68, <i>p</i> = 0.015), suggesting that the 5-FU treated OKC patients was significantly less likely to experience recurrence than the CS/MCS treated OKC patients.</p> Conclusion <p>5-FU is found to be a better alternative to CS or MCS in terms of recurrence and postoperative complications in OKC. While 5-FU and/or CS remain effective, its side effects highlight the need for safer, equally effective alternatives. Future research should focus on long-term outcomes and the efficacy of novel treatments, including herbal therapies.</p>

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Efficacy of alternative agents to Carnoy’s solution in the prevention of recurrence in odontogenic keratocyst: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年4月23日

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  • Samyuktha Aarthi,
  • Monal Yuwanati,
  • Pratibha Ramani,
  • Gheena Sukumaran

摘要

Aim

Odontogenic keratocyst (OKC) is aggressive cyst with high recurrence rates, traditionally treated using Carnoy’s solution (CS) as an adjunct to surgical enucleation. However, the toxicity and potential complications of CS, including neurotoxicity and tissue damage, necessitate the exploration of safer alternatives. The aim of systematic review was to evaluate potential alternatives to CS for preventing recurrence and minimizing postoperative complications in OKC.

Methods

Studies were searched and retrieved from PubMed, Scopus, and Web of Science using relevant keywords. Inclusion criteria focused on studies evaluating alternatives to CS for OKC treatment, while reviews, case reports, and non-clinical studies were excluded. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2 Tool. Data extraction included study design, intervention, recurrence rates, and complications. Findings were summarized descriptively. Meta-analysis (random-effect model) was performed for recurrence in OKC.

Results

Six studies met the inclusion criteria after examining 280 studies. These studies examined recurrence and post-operative complications in CS, modified CS (MCS), and 5- Fluorouracil (5-FU) treated OKC cases. The recurrence events were 15/153 with CS and 37/200 with MCS; however, no recurrence was recorded for 5-FU. Paresthesia was seen in 17/74 of OKC-treated CS/MCS cases and 12/72 of OKC-treated 5-FU cases after surgery. The random-effects model estimated a pooled risk ratio of 0.13 (95% CI: 0.02 to 0.68, p = 0.015), suggesting that the 5-FU treated OKC patients was significantly less likely to experience recurrence than the CS/MCS treated OKC patients.

Conclusion

5-FU is found to be a better alternative to CS or MCS in terms of recurrence and postoperative complications in OKC. While 5-FU and/or CS remain effective, its side effects highlight the need for safer, equally effective alternatives. Future research should focus on long-term outcomes and the efficacy of novel treatments, including herbal therapies.