Keywords
Enucleation
Topical 5-fluorouracil
Photobiomodulation therapy
Case report
How to Cite
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
References
1. Ledderhof NJ, van den Akker HP, Raghoebar GM, Vissink A, Meijer HJA. Topical 5-fluorouracil as an adjunct after enucleation of keratocystic odontogenic tumours: a pilot study. J Oral Maxillofac Surg. 2017;75(10):2118–26.
2. Lone PA, Guru S, Khanna I. Topical 5-fluorouracil application in management of odontogenic keratocyst: a comparative study. J Clin Exp Dent. 2020;12(9):e835–41.
3. Dashow JE, Pogrel MA, Podlesh S. Significantly decreased recurrence rates in keratocystic odontogenic tumors treated with Carnoy's solution. J Oral Maxillofac Surg. 2015;73(11):2143–9.
4. Al-Moraissi EA, Ellis E 3rd, Vaid NR. What surgical treatment has the lowest recurrence rate for odontogenic keratocyst? A systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2017;46(8):942–50.
5. De Freitas Gonçalves TO, et al. Management and recurrence of the odontogenic keratocyst: systematic review (2024). J Cranio-Maxillofac Surg. 2024.
6. Ma Y, et al. Photobiomodulation therapy for nerve injuries: a systematic review and meta-analysis. PLoS One. 2023;18(6):e0287833.
7. Alharbi G, et al. Efficacy of low-level laser therapy and microsurgery on neurosensory recovery: systematic review (2024). J Stomatol Oral Maxillofac Surg. 2024;125:101–9.
8. Eid MK, et al. Conservative enucleation with topical 5-Fluorouracil: a prospective study with 2-year follow-up. Int J Oral Surg. 2024.
9. Reddy GV, et al. Targeting the odontogenic keratocysts: therapeutic potential of 5-fluorouracil through thymidylate synthase inhibition. Cureus. 2025;17(2).
10. Berberi A, et al. Long-term follow-up of recurrent odontogenic keratocyst treated with topical 5-fluorouracil: 18-year case report. J Stomatol. 2023.
11. Dioguardi M, et al. Factors and management techniques in odontogenic keratocysts: systematic review (2024). Eur J Med Res. 2024;29(1):18.
12. Blanas N, et al. A systematic review of treatment and prognosis of odontogenic keratocyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(5):553–8.
13. Betancourt P, et al. Photobiomodulation therapy in peripheral nerve regeneration: review and applications. Int J Morphol. 2024;42(6):1524–30.
14. Bahrami R, et al. The impact of low-level laser therapy (photobiomodulation) on nerve repair: recent evidence (2025). Photobiomodul Photomed Laser Surg. 2025.
15. Scribante A, et al. A scoping review on laser assisted protocols for nerve sensitivity after surgical trauma (2023). Appl Sci. 2023;13(16):9258.
16. Muret M, et al. Decompression as first-intention treatment for large odontogenic keratocysts. JOMS. 2021.
17. Kaczmarzyk T, et al. A systematic review of recurrence rates for keratocystic odontogenic tumours. J Craniomaxillofac Surg. 2012;40(7).
18. Jacobs T, et al. Comparing 5-fluorouracil versus modified Carnoy's solution after enucleation: a comparative study (2024). J Oral Maxillofac Surg. 2024;82(4).
19. ClinicalTrials.gov. Study: enucleation with 5-FU vs Carnoy's solution in odontogenic cysts. NCT06096220. 2024.
20. ClinicalTrials.gov. Adjunctive methods in treatment of odontogenic keratocyst (5-FU vs MCS). NCT06820229. 2024.
21. Rojas G, Muñoz C. Effects of phototherapy laser in nerve regeneration: narrative review. Rev ADM. 2023;80(2):115–21.
22. Souza PH, Fernandes-Neto AJ, Gasperini G. Low-level laser therapy for treatment of oral nerve injuries: a systematic review. Dent Traumatol. 2024;40(3).
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2026 Daniela Alejandra Escobar Garín, Wendy Escobar-González (Autor/a)