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The Use of Carnoy’s Solution and Its Modifications for Reducing the Number of Recurrences after Surgical Removal of Keratocystic Odontogenic Tumors and Ameloblastomas: A Systematic Review

  • V. V. LebedevEmail author
  • S. B. Butsan
REVIEW
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Abstract—

The paper is a systematic review of using the pharmaceutical substance, Carnoy’s solution, to reduce the number of recurrences of such tumors as keratocystic odontogenic tumor and ameloblastoma. These are benign yet aggressive jaw tumors with a high percentage of recurrences (up to 60–80%). Surgical treatment of the above-described lesions can be performed using: (1) marsupialization (recurrence rate up to 24.8%); (2) enucleation with or without adjunct therapy; therapy may include cryotherapy with liquid nitrogen (recurrence rate up to 23.1%), peripheral ostectomy (recurrence rate up to 20%), and bone cavity treatment with Carnoy’s solution (recurrence rate up to 6.6%); (3) marginal/segmental resection of the jaw (recurrence rate up to 2.5%). Despite the low percentage of recurrences when using marginal/segmental resection, this method requires a longer and more expensive anesthetic and surgical intervention as well as longer postoperative and rehabilitation periods. With the use of Carnoy’s solution, it became possible to reduce the risks of recurrence of keratocystic odontogenic tumors and ameloblastomas from 60–80 to 6.6‒11.5%. Worldwide today, not only Carnoy’s solution recommended by Cutler and Zollinger in 1933 is applied but also its modifications that are not inferior to the original substance in terms of removal efficiency of the remaining cystic cells. The safety of the use of the solution near the vessels and nerves is confirmed by works of a number of authors. It is concluded that, despite the large number of surgical treatments of both keratocystic odontogenic tumors and ameloblastomas, enucleation with the use of Carnoy’s solution is the optimal method of choice for these diseases.

Keywords:

keratocystic odontogenic tumor ameloblastoma Carnoy`s solution recurrence surgical treatment enucleation. 

Notes

COMPLIANCE WITH ETHICAL STANDARDS

Conflict of interests. The authors declare that they have no conflict of interest.

Statement of compliance with standards of research involving humans as subjects. All scans were performed with consent of the patients and were in accordance with ethical standards of the Ethics Committee of the Central Research Institute of Dental and Maxillofacial Surgery.

REFERENCES

  1. 1.
    Philipsen, H.P., On keratocysts in the jaws, Tandlaegebladet, 1956, vol. 60, pp. 963–980.Google Scholar
  2. 2.
    de Molon, R.S., Verzola, M.H., Pires, L.C., Masca-renhas, V.I., da Silva, R.B., Cirelli, J.A., and Roberto, H.B., Five years follow-up of a keratocyst odontogenic tumor treated by marsupialization and enucleation: A case report and literature review, Contemp. Clin. Dent., 2015, vol. 6, suppl. 1, pp. 106–110.CrossRefGoogle Scholar
  3. 3.
    Philipsen, H.P., Keratocystic odontogenic tumour, Pathology and Genetics of Head and Neck Tumours. WHO Classification of Tumours, Barnes, L., Eveson, J.W., Reichart, P., and Sidransky, D., Eds., Lyon: IARC, 2005, 3rd ed., vol. 9, pp. 306–307.Google Scholar
  4. 4.
    Robles, P. and Roa, I., Keratocystic odontogenic tumor: Clinicopathological aspects and treatment, J. Oral Res., 2014, vol. 3, no. 4, pp. 249–256.CrossRefGoogle Scholar
  5. 5.
    Ljubenović, M., Ljubenović, D., Binić, I., Jovanović, D., and Stanojević, M., Gorlin-Goltz syndrome, Acta Dermatovenerol. Alp. Pannonica Adriat., 2007, vol. 16, no. 4, pp. 166–169.Google Scholar
  6. 6.
    Leger, M., Quintana, A., Tzu, J., Yee, H., Kamino, H., and Sanchez, M., Nevoid basal cell carcinoma syndrome, Dermatol. Online J., 2011, vol. 17, no. 10, p. 23.Google Scholar
  7. 7.
    Soufir, N., Gerard, B., Portela, M., Brice, A., Liboutet, M., Saiag, P., Descamps, V., Kerob, D., Wolkenstein, P., Gorin, I., Lebbe, C., Dupin, N., Crickx, B., Basset-Seguin, N., and Grandchamp, B., PTCH mutations and deletions in patients with typical nevoid basal cell carcinoma syndrome and in patients with a suspected genetic predisposition to basal cell carcinoma: A French study, Br. J. Cancer, 2006, vol. 95, no. 4, pp. 548–553.CrossRefGoogle Scholar
  8. 8.
    Tang, J.Y., Wu, A., Linos, E., Parimi, N., Lee, W., Aszterbaum, M., Asgari, M.M., Bickers, D.R., and Epstein, E.H., Jr., High prevalence of vitamin D deficiency in patients with basal cell nevus syndrome, Arch. Dermatol., 2010, vol. 146, no. 10, pp. 1105–1110.CrossRefGoogle Scholar
  9. 9.
    Pustinskii, I.N., Kropotov, M.A., Tkachev, S.I., Paches, A.I., Alieva, S.B., Yagubov, A.S., Bazhutova, G.A., and Slanina, S.V., Treatment of patients with squamous cell carcinoma of the scalp and neck, Ross. Oncol. Zh., 2013, no. 1, pp. 42–46.Google Scholar
  10. 10.
    Berenbeyn, B.A., Lezvinskaya, E.M., Krasnoshchekova, N.Yu., and Ilinskaya, T.B., Gorlin-Golts syndrome, Vestn. Dermatol., 1993, no. 5, pp. 63–67.Google Scholar
  11. 11.
    Guimarães, A.C., Santos, M.D.D.C.F., de Carvalho, G.M., Chone, C.T., and Pfeilsticker, L.N., Giant keratocystic odontogenic tumor: Three cases and literature review, Iran. J. Otorhinolaryngol., 2013, vol. 25, no. 73, pp. 245–252.Google Scholar
  12. 12.
    Stoelinga, P.J.W., Excision of the overlying, attached mucosa, in conjunction with cyst enucleation and treatment of the bony defect with Carnoy solution, Oral. Maxillofac. Surg. Clin., 2003, vol. 15, no. 3, pp. 407–414.CrossRefGoogle Scholar
  13. 13.
    Mendes, R.A., Carvalho, J.F.C., and van der Waal, I., Characterization and management of the keratocystic odontogenic tumor in relation to its histopathological and biological features, Oral Oncol., 2010, vol. 46, no. 4, pp. 219–225.CrossRefGoogle Scholar
  14. 14.
    Yashoda Devi, B.K., Rakesh, N., Nisha, A., Sagar, P., and Prasad, K., Bilateral keratocystic odontogenic tumor of mandible, Indian J. Multidiscip. Dent., 2010, vol. 1, no. 1, pp. 12–14.Google Scholar
  15. 15.
    Matijević, S., Damjanović, Z., and Cerović, S., Early reconstruction of bone defect created after initial surgery of a large keratocystic odontogenic tumor: A case report, Vojnosanit. Pregl., 2013, vol. 70, no. 8, pp. 789–793.CrossRefGoogle Scholar
  16. 16.
    Jafaripozve, N., Jafaripozve, S., and Khorasgani, M.A., Kerathocyst odontogenic tumor: Importance of selection the best treatment modality and a periodical follow-up to prevent from recurrence: A case report and literature review, Int. J. Prev. Med., 2013, vol. 4, no. 8, pp. 967–970.Google Scholar
  17. 17.
    Pindborg, J.J. and Hansen, J., Studies on odontogenic cyst epithelium: 2. Clinical and roentgenologic aspects of odontogenic keratocysts, Acta Pathol. Microbiol. Scand. Pathol., 1963, vol. 58, no. 3, pp. 283–294.CrossRefGoogle Scholar
  18. 18.
    Chrcanovic, B.R. and Gomez, R.S., Recurrence probability for keratocystic odontogenic tumors: An analysis of 6427 cases, J. Cranio. Maxillofac. Surg., 2017, vol. 45, no. 2, pp. 244–251.CrossRefGoogle Scholar
  19. 19.
    Reichart, P.A., Philipsen, H.P., and Sonner, S., Ameloblastoma: Biological profile of 3677 cases, Eur. J. Cancer B Oral Oncol., 1995, vol. 31, no. 2, pp. 86–99.CrossRefGoogle Scholar
  20. 20.
    Semkin, V.A., Grigor’yan, A.S., Babichenko, I.I., Usachev, E.S., and Zaretskaya, A.S., Features of surgical tactics in various forms of ameloblastic tumors, Stomatologiya, 2012, vol. 91, no. 4, pp. 25–27.Google Scholar
  21. 21.
    Junquera, L., Ascani, G., Vicente, J.C., Garcia–Consuegra, L., and Roig, P., Ameloblastoma revisited, Ann. Otol. Rhinol. Laryngol., 2003, vol. 112, no. 12, pp. 1034–1039.CrossRefGoogle Scholar
  22. 22.
    Juuri, E., Isaksson, C., Jussila, M., Heikinheimo, K., and Thesleff, I., Expression of the stem cell marker, SOX 2, in ameloblastoma and dental epithelium, Eur. J. Oral Sci., 2013, vol. 121, no. 6, pp. 509–516.CrossRefGoogle Scholar
  23. 23.
    Yang, R., Liu, Z., Peng, C., Cao, W., and Ji, T., Maxillary ameloblastoma: Factors associated with risk of recurrence, Head Neck, 2017, vol. 39, no. 5, pp. 996–1000.CrossRefGoogle Scholar
  24. 24.
    Semkin, V.A., Babichenko, I.I., Usachev, E.S., and Zaretskaya, A.S., Clinical and morphological characteristics of ameloblastomas, Stomatologiya, 2013, vol. 92, no. 4, pp. 40–43.Google Scholar
  25. 25.
    Gardner, D.G., Heikinheimo, K., Shear, M., Philipsen, H.P., and Coleman, H., Ameloblastomas, in Pathology and Genetics of Head and Neck Tumours. WHO Classification of Tumours, Barnes, L., Eveson, J.W., Reichart, P., and Sidransky, D., Eds., Lyon: IARC, 2005, 3rd ed., vol. 9, pp.298–302.Google Scholar
  26. 26.
    Luan, X., Ito, Y., and Diekwisch, T.G.H., Evolution and development of Hertwig’s epithelial root sheath, Dev. Dyn., 2006, vol. 235, no. 5, pp. 1167–1180.CrossRefGoogle Scholar
  27. 27.
    Nam, H., Kim, J.H., Kim, J.W., Seo, B.M., Park, J.C., Kim, J.W., and Lee, G., Establishment of Hertwig’s epithelial root sheath/epithelial rests of Malassez cell line from human periodontium, Mol. Cells, 2014, vol. 37, no. 7, pp. 562–567.CrossRefGoogle Scholar
  28. 28.
    Shaikhi, K., Neiders, M., Chen, F., and Aguirre, A., Morphological variants of ameloblastoma and their mimickers, N. A. J. Med. Sci., 2012, vol. 5, no. 1, pp. 20–28.CrossRefGoogle Scholar
  29. 29.
    Page-McCaw, A., Ewald, A.J., and Werb, Z., Matrix metalloproteinases and the regulation of tissue remodelling, Nat. Rev. Mol. Cell. Biol., 2007, vol. 8, no. 3, pp. 221–233.CrossRefGoogle Scholar
  30. 30.
    Pinheiro, J.J. V., Freitas, V.M., Moretti, A.I.S., Jorge, A.G., and Jaeger, R.G., Local invasiveness of ameloblastoma. Role played by matrix metalloproteinases and proliferative activity, Histopathology, 2004, vol. 45, no. 1, pp. 65–72.CrossRefGoogle Scholar
  31. 31.
    Kirichenko, E.N., The use of stereolithographic modeling in patients with mandibular ameloblastoma, Al’m. Sovrem. Nauki Obraz., 2014, vols. 5–6, no. 84, pp. 78–82.Google Scholar
  32. 32.
    Babichenko, I.I., Rybal’skaya, V.F., Tsimbalist, N.S., and Semkin, V.A., The proliferative activity of tumor cells and the distribution of SOX2+ pluripotent stem cells in various histological variants of ameloblastoma, Arch. Patol., 2018, vol. 80, no. 1, pp. 21–26.CrossRefGoogle Scholar
  33. 33.
    Haq, J., Siddiqui, S., and McGurk, M., Argument for the conservative management of mandibular ameloblastomas, Br. J. Oral Max. Surg., 2016, vol. 54, no. 9, pp. 1001–1005.CrossRefGoogle Scholar
  34. 34.
    Al-Moraissi, E.A., Dahan, A.A., Alwadeai, M.S., Oginni, F.O., Al-Jamali, J.M., Alkhutari, A.S., Al-Tairi, N.H., Almaweri, A.A., and Al-Sanabani, J.S., What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: A large systematic review and meta-analysis, J. Cranio Maxillofac. Surg., 2017, vol. 45, no. 1, pp. 131–144.CrossRefGoogle Scholar
  35. 35.
    Cutler, E.C. and Zollinger, R., The use of sclerosing solutions in the treatment of cysts and fistulae, Am. J. Surg., 1933, vol. 19, no. 3, pp. 411–418.CrossRefGoogle Scholar
  36. 36.
    Pitak-Arnnop, P., Chaine, A., Oprean, N., Dhanuthai, K., Bertrand, J.C., and Bertolus, C., Management of odontogenic keratocysts of the jaws: A ten-year experience with 120 consecutive lesions, J. Cranio Maxillofac. Surg., 2010, vol. 38, no. 5, pp. 358–364.CrossRefGoogle Scholar
  37. 37.
    Voorsmit, R.A.C.A., Stoelinga, P.J.W., and van Haelst, U.J.G.M., The management of keratocysts, J. Maxillofac. Surg., 1981, vol. 9, pp. 228–236.CrossRefGoogle Scholar
  38. 38.
    Madhulaxmi, M. and Abdul Wahab, P.U., Carnoy’s solution as a surgical medicament in the treatment of KCOT, Int. J. Pharma Bio Sci., 2014, vol. 5, no. 1, pp. 492–495.Google Scholar
  39. 39.
    Ecker, J., ter Horst, R., and Koslovsky, D., Current role of Carnoy’s solution in treating keratocystic odontogenic tumors, J. Oral Maxillofac. Surg., 2016, vol. 74, no. 2, pp. 278–282.CrossRefGoogle Scholar
  40. 40.
    Saulacic, N., Stajcic, Z., Stajcic, L.S., Piattelli, A., Iizuka, T., and Lombardi, T., Effects of Carnoy’s solution on blood vessels of the axillary fossa of rats, Int. J. Oral Maxillofac. Surg., 2009, vol. 38, no. 8, pp. 876–879.CrossRefGoogle Scholar
  41. 41.
    Frerich, B., Cornelius, C.P., and Wietholter, H., Critical time of exposure of the rabbit inferior alveolar nerve to Carnoy’s solution, J. Oral Maxillofac. Surg., 1994, vol. 52, no. 6, pp. 599–606.CrossRefGoogle Scholar
  42. 42.
    Gao, L., Wang, X.L., Li, S.M., Liu, C.Y., Chen, C., Li, J.W., Yan, X.J., Zhang, J., Ren, W.H., and Zhi, K.Q. Decompression as a treatment for odontogenic cystic lesions of the jaw, J. Oral Maxillofac. Surg., 2014, vol. 72, no. 2, pp. 327–333.CrossRefGoogle Scholar
  43. 43.
    Brøndum, N. and Jensen, V.J., Recurrence of keratocysts and decompression treatment: A longterm follow-up of forty-four cases, Oral Surg. Oral Med. Oral Pathol., 1991, vol. 72, no. 3, pp. 265–269.CrossRefGoogle Scholar
  44. 44.
    Nakamura, N., Mitsuyasu, T., Mitsuyasu, Y., Taketomi, T., Higuchi, Y., and Ohishi, M., Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 2002, vol. 94, no. 5, pp. 543–553.CrossRefGoogle Scholar
  45. 45.
    Afanas'ev, V.V., Khirurgicheskaya stomatologiya (Surgical Dentistry), Moscow: GEOTAR-Media, 2011.Google Scholar
  46. 46.
    Kaczmarzyk, T., Mojsa, I., and Stypulkowska, J., A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities, Int. J. Oral Maxillofac. Surg., 2012, vol. 41, no. 6, pp. 756–767.CrossRefGoogle Scholar
  47. 47.
    Johnson, N.R., Batstone, M.D., and Savage, N. W., Management and recurrence of keratocystic odontogenic tumor: A systematic review, Oral Surg. Oral Med. Oral Pathol. Oral Radiol., 2013, vol. 116, no. 4, pp. 271–276.CrossRefGoogle Scholar
  48. 48.
    Stoelinga, P.J.W., The treatment of odontogenic keratocysts by excision of the overlying, attached mucosa, enucleation, and treatment of the bony defect with Carnoy solution, J. Oral Maxillofac. Surg., 2005, vol. 63, no. 11, pp. 1662–1666.CrossRefGoogle Scholar
  49. 49.
    Tolstunov, L. and Treasure, T., Surgical treatment algorithm for odontogenic keratocyst: combined treatment of odontogenic keratocyst and mandibular defect with marsupialization, enucleation, iliac crest bone graft, and dental implants, J. Oral Maxillofac. Surg., 2008, vol. 66, no. 5, pp. 1025–1036.CrossRefGoogle Scholar
  50. 50.
    Pogrel, M.A., The keratocystic odontogenic tumor, Oral Maxillofac. Surg. Clin., 2013, vol. 25, no. 1, pp. 21–30.CrossRefGoogle Scholar
  51. 51.
    Salmassy, D.A. and Pogrel, M.A., Liquid nitrogen cryosurgery and immediate bone grafting in the management of aggressive primary jaw lesions, J. Oral Maxillofac. Surg., 1995, vol. 53, no. 7, pp. 784–790.CrossRefGoogle Scholar
  52. 52.
    Tonietto, L., Borges, H.O.I., Martins, C.A.M., Silva, D.N., and Filho, M.S., Enucleation and liquid nitrogen cryotherapy in the treatment of keratocystic odontogenic tumors: A case series, J. Oral Maxillofac. Surg., 2011, vol. 69, no. 6, pp. 112–117.CrossRefGoogle Scholar
  53. 53.
    Schmidt, B.L. and Pogrel, M.A., The use of enucleation and liquid nitrogen cryotherapy in the management of odontogenic keratocysts, J. Oral Maxillofac. Surg., 2001, vol. 59, no. 7, pp. 720–725.CrossRefGoogle Scholar
  54. 54.
    Kanoi, A.V., Banerjee, T., Sundaramurthy, N., Sarkar, A., Kanoi, P., and Saha, S., Defining giant mandibular ameloblastomas—is a separate clinical sub-entity warranted?, Indian J. Plast. Surg., 2018, vol. 51, no. 2, pp. 208–215.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Central Research Institute of Dental and Maxillofacial Surgery, Department of Maxillofacial SurgeryMoscowRussia

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