Odontogenic keratocyst of the maxilla with maxillary sinus involvement treated with enucleation and topical 5-fluorouracil: a case report: reporte de caso

Abstract

Odontogenic keratocyst is a benign odontogenic lesion characterized by locally aggressive behavior and a tendency to recur. Its occurrence in the maxilla with maxillary sinus involvement is uncommon and may pose diagnostic and therapeutic challenges because of its proximity to relevant anatomical structures. We report the case of a 22-year-old male patient who presented with swelling in the right maxilla, occasional epiphora, and intermittent rhinorrhea. Panoramic radiography and computed tomography revealed an extensive unilocular radiolucent lesion in the right maxilla, with maxillary sinus involvement, cortical thinning, deviation of the nasal cavity, and extension toward adjacent anatomical regions. Aspiration and incisional biopsy supported the diagnosis, which was subsequently confirmed by histopathological examination as a parakeratinized odontogenic keratocyst. Management consisted of surgical enucleation, cavity debridement, and adjunctive topical application of 5-fluorouracil using sterile gauze maintained in situ for 24 hours. Clinical and imaging follow-up at one week, one month, three months, and six months showed favorable healing, partial bone regeneration, and no clinical or tomographic evidence of early recurrence. This case highlights the value of comprehensive clinical and radiological assessment and suggests that enucleation combined with topical 5-fluorouracil may be a feasible adjunctive alternative in selected anatomically complex maxillary odontogenic keratocysts. However, given the risk of late recurrence, long-term follow-up remains essential.