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54 rev port estomatol med dent cir maxilofac. 2021;62(1):50-55

adjuvants, such as ostectomy or Carnoy’s solution, and de- tion due to the lower rates of recurrence and better perfor-
compression followed by enucleation. Marsupialization and mance of the solution compared to the solution modified by
16
decompression are increasingly popular treatment options removing chloroform. 13,17 A recent study of 80 patients,
for OKs to preserve adjacent structures until sufficient ossi- where 44 were treated with Carnoy and 36 with modified Car-
3
fication occurs. However, although these treatment modali- noy, concluded that recurrence was greater in patients treated
ties may decrease the cyst’s size, they do not definitively treat with the modified solution, around 35% versus 10% with the
the OK, and additional surgical intervention is generally re- original solution. This finding indicates that the original solu-
14

quired for its removal. Besides, they require regular follow- tion may still have a role in OK treatment as an adjunctive to
13
-up visits, irrigation of the cyst cavity, and repeated adjust- enucleation, reducing recurrence. A survey with 809 dental
ment of the stent. 3 surgeons in the United States revealed that 56% use the solu-
The most extensive OK treatment is osseous resection, tion with chloroform and 42% without it; 27% reported having
which has the lowest recurrence rate. However, it causes con- ceased to use it due to its unavailability in the market. 14
siderable morbidity, particularly because reconstructive mea- Despite the good results presented in numerous research-
sures are necessary to restore jaw function and esthetics. 6,8,11,14 es with Carnoy’s solution, one study showed disadvantages of
In the present case, the patient rejected resection because he its use: as it is a caustic solution, it can cause toxicity to the
preferred to have a slightly higher risk of recurrence than un- adjacent soft tissues, skin, and dental follicles if the patient is
dergo such an aggressive and mutilating treatment for a be- a child. Moreover, the authors pointed out the impossibility of
nign lesion. immediate bone grafting. 7
Carnoy’s solution, the adjuvant of choice in the present Long follow -up periods are suggested for this lesion because
7
case, is composed of ethanol, chloroform, glacial acetic acid, recurrence can occur up to 10 years after the initial treatment.
6
and ferric chloride. Enucleation associated with Carnoy’s solu- It is recommended to reassess the patient every 6 months, as
13
tion showed good results in a previous study by Leung et al., has been done in the present case. An early diagnosis of recur-
where its recurrence rate was 11.4%, with minimal morbidity. rence can be treated with conservative approaches. 12
15
A similar rate, 11.5%, was found by Al -Moraissi et al., who As OK is an asymptomatic lesion in its early stages, it is
considered this method the primary treatment for OKs. Da- essential that the general dentist pays attention during radio-
16
show et al., however, obtained a significantly lower recur- graphic evaluations, carefully observing all the bone structures
rence rate, 4.8%, pointing it as the lowest recurrence among and not just the teeth. Early diagnosis is important so that
conservative treatments. Chrcanovic and Gomez obtained a more conservative surgical treatments can be performed. In
11
similar result, 5.3%, and considered it the lowest recurrence the present case, despite the advanced stage of bone destruc-
2
among the treatment modalities. Ribeiro -Júnior et al. conclud- tion, enucleation associated with Carnoy’s solution has proved
ed that Carnoy’s solution and peripheral ostectomy had similar to be quite effective so far. Long -term radiographic follow -up
efficacy in OK management. On the other hand, Karaca et al. is mandatory to establish how successful this treatment real-
6
compared the two modalities and concluded that peripheral ly was.
ostectomy had a statistically higher recurrence than Carnoy’s
solution, around 18.2% versus only 5.3%, respectively. In the
present case, peripheral ostectomy was not considered a treat- Ethical disclosures
ment option in order not to fragilize the mandible even more.
Carnoy’s solution is a chemical cauterization agent that Protection of human and animal subjects. The authors
was first used as a fixative agent in histology but has been declare that no experiments were performed on humans or
used in the treatment of injuries due to its power to penetrate animals for this study.

14
tissues, local fixation, and ability to promote hemostasis. It
causes superficial tissue necrosis, from a chemical cauteriza- Confidentiality of data. The authors declare that they have
followed their work center protocols on access to patient data
tion up to 1.5 -mm deep after 5 minutes of application in bone
stores, and eliminates tumor cells. 13,17 Its application method and for its publication.

consists of protecting neighboring tissues with sterile gauze, Right to privacy and informed consent. The authors have
coating the bone cavity with gauze, and applying the solution obtained the written informed consent of the patients or sub-
for 3 minutes, followed by irrigation with a saline solution. This jects mentioned in the article. The corresponding author is in
procedure, repeated three times, was the same performed in possession of this document.
13
our clinical case. Some authors believe that the use of Car-
noy´s solution after enucleation in areas of bone fenestration
may help eliminate residual microcysts on the overlying soft Conflict of interest
tissue, and its effects may be superior compared to using cu-
rettage or peripheral ostectomy as the adjunctive procedure. 9 The authors have no conflicts of interest to declare.
In 1992, the United States Food and Drug Administration
(FDA) prohibited the use of chloroform in the composition of references
Carnoy due to being a carcinogen, and the modified Carnoy
solution was then created. 14,16,17 The 3 ml of chloroform were 1. Tekkesin MS, Wright JM. The World Health Organization
replaced by 3 ml of absolute alcohol. However, studies’ results Classification of Odontogenic Lesions: A Summary of the
support the relevance of maintaining chloroform in the solu- Changes of the 2017. Turk Patoloji Derg. 2018;34:1 -18.