Current Role of Carnoy's Solution in Treating Keratocystic Odontogenic Tumors
Due to the high recurrence rate of KCOTs, a majority of the literature on Carnoy’s solution includes systematic reviews analyzing the surgical procedures for treating the cystic lesion with the lowest recurrence rates (Morgan, 2005). However, more recently, the composition of Carnoy’s solution has become a source of disaccord. The FDA has imposed a ban on pharmacies compounding therapeutic agents containing chloroform, currently listed as a carcinogenic agent. Some pharmacies are manufacturing a “modified” version of the solution without chloroform, although there is little evidence regarding the effectiveness of this chloroform-free solution. This has led to widespread confusion regarding the obtainment and use of “true” Carnoy’s solution. Many pharmacies and practitioners alike are not sure whether to classify Carnoy’s solution a therapeutic agent or a medical device; the latter requires no restriction on the use of chloroform.
In an attempt to clarify some of the confusion that surrounds this topic of discussion, a short questionnaire was drafted and distributed to members of the American Association of Oral and Maxillofacial Surgeons (AAOMS). The questionnaire was administered by kwiksurveys.com and distributed to the members of AAOMS via electronic mail. The survey is anonymous, but demographic information (e.g. location of practice) was obtained through the survey.
All data was analyzed using Microsoft excel.
To date, 794 participants have responded to the survey (approximately 12% response rate). About one quarter of the participants currently use Carnoy’s solution, of which, 82 are using the solution with chloroform and 109 are using it without chloroform. New York has the most surgeons using Carnoy’s solution with chloroform (N=19), followed by Texas (N=9). Concerning the surgeons that have used the solution in the past but do not currently use Carnoy’s solution, 85 participants claimed they no longer use Carnoy’s because it is too difficult to obtain the solution with chloroform. The most popular answer (N=202) for why people aren’t currently using Carnoy’s solution is because they no longer are performing chemical curettage for their pathology cases. The most common procedures done when definitively treating a KCOT was Enucleation + Mechanical Curettage (Curette and/or Peripheral Ostectomy) (N=523) followed by Enucleation + Mechanical Curettage + Chemical Curettage (Carnoy’s Solution) (N=178).
Although the use of Carnoy’s solution isn’t the most common treatment option when definitively treat a KCOT, over 22% of the participants use Carnoy’s as part of their principle treatment option. Of the surgeons currently using Carnoy’s solution, 42% are using the solution with chloroform. Interestingly, NY has the highest number of people using Carnoy’s with chloroform despite New York Presbyterian Hospital, one of the state’s largest hospital groups, banning the use of the Carnoy’s solution containing chloroform. With the present dichotomy of Carnoy’s solution with or without chloroform, more information is required to determine the optimal conditions and composition of this popular treatment modality.
Morgan TA, Burton CC, Qian F. A retrospective review of treatment of the odontogenic keratocyst. J Oral Maxillofac Surg 2005;63:635–9.
Voorsmit RA, Stoelinga PJ, van Haelst UJ. The management of keratocysts. J Maxillofac Surg 1981;9:228–36.