Significantly Decreased Recurrence Rates in Keratocystic Odontogenic Tumor With Simple Enucleation and Curettage Using Carnoy's Versus Modified Carnoy's Solution

Abstract

A variety of modalities has been suggested for treatment of keratocystic odontogenic tumor (KOT), including Carnoy's solution (CS) and modified Carnoy's (without chloroform) solution (MC). The purpose of the present study was to investigate the effect of CS versus MC as it relates to the KOT recurrence rates when used in conjunction with simple enucleation and curettage (E&C) for treatment of KOT. A retrospective cohort study of patients with a pathologic diagnosis of KOT treated with E&C and application of CS or MC by 3 surgeons at a single center from January 1996 to April 2014 was completed. The demographic, clinical, radiographic, and histologic data were collected for each patient. All disease recurrences were confirmed by biopsy. The primary outcome variable of the study was the interval to recurrence, with the predictor of CS versus MC. Other variables included in the analysis were gender, age, surgeon, and lesion location. Multivariate analysis, including the Wilcoxon test and χ(2) test of associations, was performed. A total of 210 patient medical records were reviewed, with 80 patients meeting the final study criteria. Of the 80 patients, 44 were in the CS arm and 36 in the MC arm. The median age was 47years (range 10 to 89) in the CS group and 50years (range 14 to 72) in the MC group (P= .70). Women accounted for 43% (19 of 44) and 44% (16 of 36) of the patients in the CS and MC treatment arms, respectively (P=.91). The lesions were found in the mandible in 26 of the 44 patients (59%) treated with CS and 22 of the 36 patients (61%) treated with MC (P= .85). Surgeon 1 treated 37 of the 44 patients (84%) and 21 of 36 patients (58%) in the CS and MC groups, respectively (P= .01). The recurrence rate was 10% for the CS arm and 35% for the MC arm (P= .027; hazard ratio 6.9). In the present retrospective study, the recurrence rate of KOTs treated by E&C with application of CS is significantly lower than that of MC. The data provided could be considered by the Food and Drug Administration for a clinical trial of CS in patients with KOT.