Comparing 5-Fluorouracil Versus Modified Carnoy's Solution for the Treatment of Odontogenic Keratocysts: A Systematic Review and Meta-Analysis

Abstract

PurposeThe primary aim of this study was to compare time to odontogenic keratocyst (OKC) recurrence with 5-fluorouracil (5-FU) versus modified Carnoy’s solution (MCS) following enucleation and curettage (EC) and peripheral ostectomy. The secondary aim was to compare the frequency (%) of permanent peripheral nerve injury characterized by hypoesthesia and neuropathic pain present at 12 months or more after surgery with 5-FU versus MCS. MethodsThe Cox hazard ratio (HR) was calculated to compare time to recurrence between the two groups. To compare the frequencies of permanent nerve damage, we fitted a fixed-effects model to the data and calculated the risk ratio (RR). Other variables collected were sex, age, follow-up time, and cyst size. ResultsNo significant differences in sex, age, follow-up time, and cyst size were found. The median follow-up time for all patients was 60 months (range: 12 - 180 months, Q1 = 32 months, Q3 = 86 months, interquartile range (IQR) = 54 months). Of the 114 patients treated with MCS, 27 recurrences with a median recurrence time of 42 months (range = 12 - 108 months, Q1 = 26.3 months, Q3 = 54 months, IQR = 27.7 months) were recorded; no recurrences were observed among the 99 patients treated with 5-FU (HR = 0.02, 95% CI = 0.00018 - 0.16, p = 2.27e-07). Of the 112 patients treated with MCS, there were 20 (17.86%) instances of permanent peripheral nerve injury; of the 98 patients treated with 5-FU, there were 7 (7.14%) instances of permanent peripheral nerve injury (RR = 0.44, 95% CI = 0.20-0.97, p = 0.04). ConclusionThe results of this meta-analysis significantly favored 5-FU over MCS for lower OKC recurrence and peripheral nerve injury, supporting the use of 5-FU as the superior adjuvant following EC and peripheral ostectomy for the treatment of OKCs.