Mandibular Odontogenic Keratocyst Managed with Enucleation, Topical 5-Fluorouracil, and Laser Photobiomodulation: A Case Report

Abstract

Odontogenic keratocyst (OKC) is locally aggressive and exhibits a high recurrence rate. This case supports a conservative, multimodal strategy combining enucleation, topical 5-fluorouracil (5-FU), and laser photobiomodulation to optimize local control and postoperative neurosensory recovery. A man in his sixth decade presented with slowly progressive right mandibular swelling and functional discomfort; examination revealed facial asymmetry and cortical expansion. Panoramic radiography demonstrated a well-defined radiolucency extending from the mandibular angle to the ascending ramus on the right. The diagnosis of OKC was confirmed after enucleation and histopathological assessment. Management consisted of complete enucleation with intracavitary topical 5-FU and adjunctive photobiomodulation for mild postoperative paresis. At 12-month clinical and radiographic follow-up, there was no evidence of recurrence or residual disease, with satisfactory functional recovery and progressive neurosensory improvement. A conservative multimodal protocol may reduce OKC recurrence with low morbidity; prolonged follow-up and standardization of 5-FU dosing/exposure and photobiomodulation dosimetry are warranted