J Korean Assoc Oral Maxillofac Surg.  2021 Feb;47(1):40-46. 10.5125/jkaoms.2021.47.1.40.

Conservative management with Carnoy’s solution in ameloblastoma involving two unerupted teeth: a report of two cases

• Lee SM
• Ku JK
• Leem DH
• Baek JA
• Ko SO

• KMID: 2513428
• DOI: http://doi.org/10.5125/jkaoms.2021.47.1.40

Abstract

Marsupialization is widely used as a primary treatment modality for reducing size of large cysts. However, there is no recommendation for specific duration of marsupialization. In addition, Carnoy’s solution usually is applied at the time of enucleation as a fixative agent. In this report, we present an appropriate marsupialization duration of ameloblastoma involving two unerupted teeth. In this present study, marsupialization using a Foley catheter was performed in two cases of ameloblastoma of the mandible involving two adjacent impacted teeth. Carnoy’s solution was applied for 3-5 minutes after enucleation in both patients. Periodically during marsupialization, the size of the radiolucency was measured in panoramic view, and clinical examination was performed. No remarkable paresthesia or soft tissue injury was observed after application of Carnoy’s solution or during follow-up. We recommend 12 to 16 weeks as an adequate marsupialization duration for a large ameloblastoma involving two impacted teeth based on increased radiopacity along the margins of the lesions. Poor oral hygiene was an issue after 12 weeks of marsupialization in one case. There were no remarkable complications with Carnoy’s solution in either case. The Foley tube has a two-way system that is more effective for irrigating the cavity than is the conventional one-way system.

Keyword

Ameloblastoma; Decompression; Carnoy’s solution; Conservative treatment

Figure

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  Fig. 1 A. Panoramic view on the first visit (4.2 cm×2.0 cm). B, C. Computed tomography coronal view on the first visit. D. Periapical standard radiograph on the first visit. E. Intraoral photo just after marsupialization using the Foley tube.

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  Fig. 2 A. 16-Fr Foley catheter (Yushin Medical & Trading). B. Cross-section of the Foley catheter.

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  Fig. 3 Panoramic view at (A) first visit, (B) 10 weeks after marsupialization, and (C) 15 weeks after marsupialization.

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  Fig. 4 A. Preoperative intraoral lesion. B. Removal of the main mass (4.5 cm×2 cm) and small mass (2 cm×1.5 cm). C. #46 distal root resorption. D. Postoperative panoramic view.

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  Fig. 5 A. Open dressing with furacin gauze was changed twice a week. B. Seven weeks after enucleation.

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  Fig. 6 Radiograph on the first visit. A. Panoramic view (4.5 cm×8.1 cm). B. Coronal view on computed tomography (CT), mandibular cortical bone was flattened and dilated. C. On sagittal CT, the mandibular inferior border was very thin.

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  Fig. 7 A. First visit. B. At seven weeks of marsupialization, increase of radiopacity on the superior border of the lesion and woven bone formation on the margin of the lesion were noted. C. At 16 weeks of marsupialization, radiopacity was increased, although the size of the lesion did not exhibit remarkable change.

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  Fig. 8 A. Postoperative panoramic view. B. Removal of the main mass (4 cm×5.5 cm) and a small mass (2 cm×2.5 cm).

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  Fig. 9 Radiograph after 22 weeks of marsupialization. A. Panoramic view on #45 distal, posterior, and inferior borders of the lesion: radiopacity was increased. B. Coronal view on computed tomography (CT): new bone formation was observed along the mass removal area. C. Sagittal view on CT: new bone formation was observed along the mass removal area. D. Intraoral photograph at 22 weeks of cyst enucleation: furacin gauze was changed every week. E. Soft tissue healing was observed after 22 weeks of cyst enucleation.

Reference

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