Role of carnoy’s solution in the treatment of keratocystic odontogenic tumor: A systematic review

Abstract

Introduction and ObjectiveThe keratocystic odontogenic tumor is a benign but aggressive neoplasm. As enucleation alone obtains high recurrence rates, some adjuvant treatments such as Carnoy’s solution have been proposed. The aim of this study is to evaluate the reduction of recurrences with the use of Carnoy’s solution as adjuvant in the treatment of keratocystic odontogenic tumors.Material and MethodsAn electronic search in Pubmed (MEDLINE), ScienceDirect and Cochrane databases was conducted with the key words “odontogenic keratocyst”, “keratocystic odontogenic tumor”, “carnoy’s solution”, “treatment” and “enucleation”. The inclusion criteria were clinical studies using Carnoy’s solution as adjuvant for the treatment of keratocystic odontogenic tumors, published in English, including at least 10 patients. Articles with an unclear reporting of the treatment applied, nonhuman studies, case reports and lesions associated to Gorlin-Goltz syndrome were excluded.ResultsAll the studies included were case series. The recurrence rate of enucleation ranged from 0% to 58.8%. With the only use of Carnoy’s solution as adjuvant treatment to the enucleation, recurrences varied from 0% to 100%. The use of ≥ 2 adjuvant treatments reduced the range between 0% and 7.9%.ConclusionsThe use of Carnoy’s solution as adjuvant therapy for the treatment of keratocystic odontogenic tumor has a grade C recommendation. Key words:Carnoy’s solution, keratocystic odontogenic tumor, treatment, recurrence.

Association of Treatment and a 3-D image follow - up on a Recurrent Keratocyst

“…In addition, the use of decompression before enucleation has been associated with a decrease in the recurrence rate of the lesion since that procedure stimulates fibrotic changes to thicken the cystic membrane diminishing potential membrane tearing during the enucleation process 23,24 . Thus, our surgical conduct by enucleation + osteotomy has been shown as the same rate recurrence as a resection 15,25 .…”

Surgical Treatment of Odontogenic Keratocyst with Application of Carnoy's Solution: Case Report

“…10. Pazdera J, Kolar Z, Zboril V, Tvrdy P, Pink R. Odontogenic keratocysts/keratocystic odontogenic tumours: biological of recurrence have been described for this lesion, depending mainly of treatment modality applied to each case 9 . The treatment of this lesion remains controversial and several surgical modalities have proven to decrease the rate of recurrence, including enucleation, curettage, marsupialization, decompression, application with Carnoy solution, cryotherapy with liquid nitrogen, and resection (with or without loss of continuity of the mandible) 6 .…”

“…More invasive treatments include approaches to the remnant bone bed (peripheral ostectomy, application of Carnoy solution or cryotherapy) or even the resection of the lesion 7.9 . The choice of treatment should be based on multiple factors, such as patient's age, size and location of the cyst, involvement of tissues and prior history of treatment [7][8][9] . The objective should be the choice of a treatment modality that involves the lower risk of recurrence and lower morbidity potential 1,3,7,8 .…”

“…The Carnoy solution is a cautery agent that causes a rapid surface chemical necrosis 9 . The solution was initially described to be used within the cyst to facilitate the complete removal of the cystic membrane and more currently is applied directly on the remnant bone bed after the enucleation fi brosis to detect and eliminate the remainder of the keratocyst epithelium, reducing the likelihood of recurrence 8,9 .…”

“…It is also likely that it penetrates spongy spaces and thus, devitalizes and binds to cystic cells 8 . The solution is composed of 1 g of ferric chloride dissolved in 6 ml of absolute alcohol, 3 ml of chloroform and 1 ml of acetic acid 9 . The reformulated solution is generally accepted since that the exposure to chloroform has been associated with cancer and toxicity 8 .…”