Refined Topical 5-Fluorouracil Technique for the Targeted Treatment of Odontogenic Keratocysts

An innovation in the treatment of odontogenic keratocysts (OKCs) is the adjunctive application of 5-fluorouracil (5-FU). Although the original approach remains effective, it may often be a challenge for the patient to return postoperatively and/or tolerate non-resorbable packing removal. The purpose of the present study is to determine whether our refined approach, where we directly apply 5-FU-coated absorbable gelatin sponge to the surgical cavity, would be an effective treatment for OKCs with similar efficacy as with our original approach.

A retrospective case series studying the treatment efficacy of our refined topical 5-FU approach on OKCs was reviewed. The study population was composed of all patients presenting for evaluation and management of OKCs with our refined technique between September 1, 2017 and July 1, 2022 at Stony Brook University Hospital. The primary outcomes included 1) time to OKC recurrence, and 2) incidence of trigeminal nerve injury following OKC treatment with the refined topical 5% 5-FU technique. Other study variables included age, gender, tumor location, and tumor size. Data analyses included descriptive statistics reported as median [interquartile range], and Kaplan-Meier survival analysis for time to OKC recurrence.

Thirteen patients with 15 OKCs were reviewed (6 women and 7 men). There were no OKC recurrences with a median follow-up time of 28.5 (24) months. Normal bony healing was observed in all cases and there were no adverse local or systemic events, no alterations in sinus function, and no incidences of infraorbital or inferior alveolar nerve paresthesia.

Our case series demonstrates that this refinement further increases technical ease, decreases operating time, and precludes the need for packing removal, with similar efficacy as the original approach.