The use of liquid nitrogen cryotherapy in the management of locally aggressive bone lesions

doi:10.1016/S0278-2391(10)80172-7

Journal of Oral and Maxillofacial Surgery

Volume 51, Issue 3, March 1993, Pages 269-273

https://doi.org/10.1016/S0278-2391(10)80172-7 Get rights and content

Cryosurgery has a unique role in the management of locally aggressive osseous lesions. By using a combination of enucleation and cryosurgery to devitalize the surrounding bone, the need for segmental mandibular resection is decreased. This article reviews 37 cases managed successfully in this manner.

References (34)

SmithJJ et al.
An estimation of tissue damage and thermal history in the cryolesion
Cryobiology
(1974)
ZacarianSA et al.
Cryogenic temperature studies of human skin. Temperature recordings at two millimeter human skin depth following application with liquid nitrogen
J Invest Dermatol
(1967)
GageAA
Cryosurgery of oral and pharyngeal carcinoma
Am J Surg
(1969)
LeopardPJ
Cryosurgery and its application to oral surgery
Br J Oral Surg
(1975)
BradleyPF et al.
The cryosurgery of bone, an experimental and clinical assessment
Br J Oral Surg
(1975)
PopescuV et al.
Bone resection, extra corporal cryotherapy and immediate re-implantation in the treatment of mandibular tumours
J Maxillofac Surg
(1980)
WeaverAW et al.
Frozen autogenous mandibular stent-graft for immediate reconstruction in oral cancer surgery
Am J Surg
(1973)
TollerPA
Newer concepts of odontogenic cysts
Int J Oral Surg
(1972)
JensenJ et al.
A comparative study of treatment of keratocysts by enucleation or enucleation combined with cryotherapy; a preliminary report
J Craniomaxillofac Surg
(1988)
SguazziA et al.
A historical account of the technical means used in cryotherapy
Min Med
(1974)

RosenG et al.

Cryosurgery for basal cell carcinoma of the head and neck

S Afr Med J

(1979)

WhittakerDK

Mechanisms of tissue destruction following cryosurgery

Ann R Coll Surg Engl

(1984)

Le PivertPJ

Basic consideration of the cryolesion

BuchB et al.

Microscopic changes in rat tongue following experimental cryosurgery

J Oral Pathol

(1979)

BradleyPF

Thermography as an aid to cryosurgery

Acta Thermographica

(1977)

EmmingsFG et al.

Cryotherapy for benign lesions of the oral cavity

J Oral Surg

(1967)

ReadePC

Cryosurgery in clinical dental practice

Int Dent J

(1979)

Cited by (82)

Safety and efficacy of adjunctive therapy in the treatment of odontogenic keratocyst: a systematic review
2023, British Journal of Oral and Maxillofacial Surgery
The odontogenic keratocyst (OKC) is a common cystic lesion in the jaw. Its management, however, is highly debated with no consensus on the best treatment option. Clinicians base their approach on treatment efficacy and associated morbidity. Management often consists of enucleation with peripheral ostectomy and adjunctive therapy to prevent recurrence. The aim of our systematic review was to evaluate the safety and efficacy of these different modalities. Embase, Medline, and Cochrane were searched according to the PRISMA guidelines for articles that presented non-syndromic patients with histopathologically confirmed OKC treated with 5-fluorouracil (5FU), Carnoy’s solution (CS), or modified Carnoy’s solution (MCS) as adjunctive therapy after enucleation and peripheral ostectomy. The outcomes of interest were safety (measured as adverse events) and efficacy (expressed as recurrence). Risk of bias was evaluated using the Newcastle-Ottawa scale. Four studies were included and 62 patients were evaluated. The results show that recurrence occurred only in patients treated with MCS. Reported adverse events were mostly limited to paraesthesia that could be permanent (in the CS and MCS treatment groups) or transient (across all adjunctive therapies). With the prohibition of CS, both MCS and 5FU are promising replacement adjunctive therapies. From a safety and efficacy perspective we consider 5FU, which was associated with the lowest recurrence and fewest adverse events, to be the most viable option. More high-evidence prospective studies, such as randomised controlled trials, with a longer follow-up period are necessary to draw definite conclusions.
Fourteen-year study of the management of the odontogenic keratocyst. Are adjunctive therapies all they are cut out to be?
2022, British Journal of Oral and Maxillofacial Surgery
Odontogenic keratocysts (OKC) are benign, developmental, locally-aggressive odontogenic cystic lesions with a high risk of recurrence. As such, the most effective treatment modalities remain controversial. The mainstay of treatment remains enucleation with or without decompression. The use of adjunctive therapies is widely reported. Our aim was to review our experience of OKCs and therefore identify the treatment modality, if there is any single one, with the lowest rate of recurrence. We also aimed to identify any common themes linking those patients experiencing cystic recurrence. Data were collected on 50 patients treated at UHCW NHS Trust over a 14-year period (2005-2018) via an anonymised database. Surgical pathways were analysed, including details of the location of the cysts and the use of adjunctive therapies, namely; mechanical debridement, cryotherapy, and the use of Carnoy’s solution. Fifty-six keratocysts, both primary (91%, n = 51) and recurrent (9%, n = 5) were included. A total of 6% of patients had a pre-existing diagnosis of Gorlin-Goltz Syndrome (n = 3). Enucleation was performed in an approximately 3:1 ratio to decompression with secondary enucleation (n = 41:15). Twenty-seven percent of patients had adjunctive therapies (n = 15). There was a 12% recurrence rate (n = 6) found only within the group of primary cysts that had been enucleated only. Notably, there were no recurrences in those cysts that had undergone adjunctive therapy. None of the cysts that underwent initial decompression or marsupialisation recurred. Following surgical intervention, no tertiary recurrent cysts were detected postoperatively. This study demonstrated the advantage of establishing a correct diagnosis prior to definitive treatment. Initial decompression in selected patients followed by enucleation, along with adjunctive therapies showed a benefit in reducing recurrences. However, in the absence of high-quality evidence for the most effective management of odontogenic keratocysts, finding a common approach will remain controversial.
Chemical adjuncts and cryotherapy in the management Of odontogenic keratocysts: A systematic review
2021, Advances in Oral and Maxillofacial Surgery
Odontogenic keratocysts are benign lesions but are locally aggressive, forming multiple daughter cysts which have a tendency to recur. Practitioners who advocate a conservative approach suggest enucleating the lesion and then treating the residual bony cavity with an adjunctive therapy in order to minimise the possibility of recurrence. Many forms of adjunctive therapy have been described such as cryotherapy, chemical cauterisation with Carnoy's or Modified Carnoy's solution and the use of topical 5-fluorouracil (5-FU) but there has not been a systematic review to compare these various adjunctive treatments in the management of odontogenic keratocysts.
PRISMA guidelines for systematic reviews were followed. An electronic literature search from the databases Medline, PubMed, the Cochrane database and the Web of Sciences were performed, and relevant articles were selected based on the inclusion criteria. Disputes were resolved by an independent third party. Statistical analysis was performed to identify trends of recurrence for each treatment arm.
A total of 28 studies managing a total of 1430 odontogenic keratocysts were included in the review. It was observed that only Carnoy's solution resulted in statistically different outcomes compared to no adjunct therapy. There was weak evidence on the efficacy of modified Carnoy's solution but no evidence that cryotherapy or 5-FU resulted in statistically different outcome compared to no adjunct therapy.
Carnoy's solution appears to be the best adjunct therapy for now but further studies are needed to establish the roles of modified Carnoy's solution, cryotherapy and 5-FU in the management of odontogenic keratocyst.
Adjunctive Strategies for Benign Maxillofacial Pathology
2019, Oral and Maxillofacial Surgery Clinics of North America
Controversies in Oral and Maxillofacial Pathology
2017, Oral and Maxillofacial Surgery Clinics of North America
Citation Excerpt :
When treated by treatment less than resection (eg, enucleation), much higher rates are reported (20%–90%).93–96 Despite the difference in outcomes, many investigators report on and suggest alternatives to resection with negative margins.97–100 The most common advocacy for “conservative” management is the classification of ameloblastoma as a “benign” process.
Results of the treatment of keratocystic odontogenic tumours using enucleation and treatment of the residual bony defect with Carnoy's solution
2016, International Journal of Oral and Maxillofacial Surgery
This retrospective study aimed to investigate the recurrence rate of keratocystic odontogenic tumours (KCOTs) treated by enucleation and the application of Carnoy's solution, and to assess the surgical morbidities associated with this treatment. KCOTs treated using a standard protocol of enucleation and the application of Carnoy's solution between 1990 and 2013 were evaluated. One hundred and five KCOTS in 105 patients (54 male, 51 female) were analysed. The mean follow-up period was 86.6 months (range 24–313 months). The recurrence rate was 11.4%. A postoperative inferior alveolar nerve neurosensory deficit occurred in 30.1% of the mandibular cases, with 16% of these being permanent. The postoperative infection and fracture rates were 1.9% and 0.9%, respectively. Younger age, multilocular KCOTs, larger tumour size, and longer antero-posterior lesion length on the radiograph were found to be risk factors for recurrence. It is concluded that enucleation and the application of Carnoy's solution to treat KCOTs results in a relatively low recurrence rate and a low rate of surgical morbidities.

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The use of liquid nitrogen cryotherapy in the management of locally aggressive bone lesions

Cryobiology

J Invest Dermatol

Am J Surg

Br J Oral Surg

Br J Oral Surg

J Maxillofac Surg

Am J Surg

Int J Oral Surg

J Craniomaxillofac Surg

A historical account of the technical means used in cryotherapy

Min Med

Cryosurgery for basal cell carcinoma of the head and neck

S Afr Med J

Mechanisms of tissue destruction following cryosurgery

Ann R Coll Surg Engl

Basic consideration of the cryolesion

Microscopic changes in rat tongue following experimental cryosurgery

J Oral Pathol

Thermography as an aid to cryosurgery

Acta Thermographica

Cryotherapy for benign lesions of the oral cavity

J Oral Surg

Cryosurgery in clinical dental practice

Int Dent J