Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Br J Oral Maxillofac Surg. 2023 Jun;61(5):331-336. doi: 10.1016/j.bjoms.2023.04.006. Epub 2023 Apr 25.
The odontogenic keratocyst (OKC) is a common cystic lesion in the jaw. Its management, however, is highly debated with no consensus on the best treatment option. Clinicians base their approach on treatment efficacy and associated morbidity. Management often consists of enucleation with peripheral ostectomy and adjunctive therapy to prevent recurrence. The aim of our systematic review was to evaluate the safety and efficacy of these different modalities. Embase, Medline, and Cochrane were searched according to the PRISMA guidelines for articles that presented non-syndromic patients with histopathologically confirmed OKC treated with 5-fluorouracil (5FU), Carnoy's solution (CS), or modified Carnoy's solution (MCS) as adjunctive therapy after enucleation and peripheral ostectomy. The outcomes of interest were safety (measured as adverse events) and efficacy (expressed as recurrence). Risk of bias was evaluated using the Newcastle-Ottawa scale. Four studies were included and 62 patients were evaluated. The results show that recurrence occurred only in patients treated with MCS. Reported adverse events were mostly limited to paraesthesia that could be permanent (in the CS and MCS treatment groups) or transient (across all adjunctive therapies). With the prohibition of CS, both MCS and 5FU are promising replacement adjunctive therapies. From a safety and efficacy perspective we consider 5FU, which was associated with the lowest recurrence and fewest adverse events, to be the most viable option. More high-evidence prospective studies, such as randomised controlled trials, with a longer follow-up period are necessary to draw definite conclusions.
牙源性角化囊肿（OKC）是颌骨中常见的囊性病变。然而，其治疗方法存在很大争议，对于最佳治疗选择尚无共识。临床医生根据治疗效果和相关发病率来制定治疗方案。治疗通常包括切除囊肿和边缘性颌骨切除术，并辅以辅助治疗以预防复发。我们进行这项系统评价的目的是评估这些不同方法的安全性和疗效。根据 PRISMA 指南，我们在 Embase、Medline 和 Cochrane 数据库中搜索了非综合征患者的文章，这些患者的病理证实为 OKC，在切除囊肿和边缘性颌骨切除术之后，接受了 5-氟尿嘧啶（5FU）、Carnoy 溶液（CS）或改良 Carnoy 溶液（MCS）作为辅助治疗。感兴趣的结局包括安全性（以不良事件衡量）和疗效（以复发表示）。使用纽卡斯尔-渥太华量表评估偏倚风险。纳入了 4 项研究，共 62 名患者。结果显示，只有接受 MCS 治疗的患者才出现复发。报告的不良事件大多局限于感觉异常，感觉异常可能是永久性的（在 CS 和 MCS 治疗组）或短暂性的（所有辅助治疗）。随着 CS 的禁用，MCS 和 5FU 都是很有前途的替代辅助治疗方法。从安全性和疗效的角度来看，我们认为 5FU 是最可行的选择，因为它与最低的复发率和最少的不良事件相关。需要更多具有更长随访时间的高证据前瞻性研究，如随机对照试验，以得出明确的结论。
