Aarthi Samyuktha, Yuwanati Monal, Ramani Pratibha, Sukumaran Gheena
Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamilnadu, India.
Evid Based Dent. 2025 Apr 23. doi: 10.1038/s41432-025-01138-3.
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.
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.
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.
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.
牙源性角化囊肿（OKC）是一种侵袭性囊肿，复发率高，传统上使用卡诺氏液（CS）作为手术摘除的辅助手段。然而，CS的毒性和潜在并发症，包括神经毒性和组织损伤，使得有必要探索更安全的替代方法。本系统评价的目的是评估CS的潜在替代方法，以预防OKC复发并将术后并发症降至最低。
使用相关关键词在PubMed、Scopus和Web of Science上检索和获取研究。纳入标准侧重于评估OKC治疗中CS替代方法的研究，同时排除综述、病例报告和非临床研究。使用纽卡斯尔-渥太华量表和Cochrane偏倚风险2工具进行质量评估。数据提取包括研究设计、干预措施、复发率和并发症。结果进行描述性总结。对OKC的复发情况进行荟萃分析（随机效应模型）。
在审查280项研究后，有6项研究符合纳入标准。这些研究检查了CS、改良CS（MCS）和5-氟尿嘧啶（5-FU）治疗的OKC病例的复发情况和术后并发症。CS组的复发事件为15/153，MCS组为37/200；然而，5-FU组未记录到复发。术后，CS/MCS治疗的OKC病例中有17/74出现感觉异常，5-FU治疗的OKC病例中有12/72出现感觉异常。随机效应模型估计合并风险比为0.13（95%CI：0.02至0.68，p = 0.015），表明5-FU治疗的OKC患者复发的可能性明显低于CS/MCS治疗的OKC患者。
就OKC的复发和术后并发症而言，发现5-FU是CS或MCS的更好替代方法。虽然5-FU和/或CS仍然有效，但其副作用凸显了对更安全、同样有效的替代方法的需求。未来的研究应关注长期结果和新治疗方法的疗效，包括草药疗法。
