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Case Report | Surgery | Volume 15 Issue 7, July 2026 | Pages: 114 - 118 | India
Open Dressing as an Adjunct to Enucleation with Chemical Cauterization and Peripheral Ostectomy in the Management of Mandibular Odontogenic Keratocyst: A Case Report
Abstract: Background: Odontogenic keratocyst (OKC) is a benign but locally aggressive developmental odontogenic cyst characterized by a high propensity for recurrence because of its thin friable epithelial lining, satellite cysts, and infiltrative growth pattern. Although several treatment modalities have been described, an ideal approach should minimize recurrence while preserving mandibular continuity and function. Case Presentation: A 58-year-old female presented with pain and swelling in the right posterior mandibular region of one month's duration. Clinical examination revealed tenderness in relation to teeth 46-48 with mild extraoral swelling over the right mandibular body. Orthopantomography demonstrated a well-defined radiolucent lesion extending from the distal aspect of tooth 46 to the posterior mandible, approaching the inferior border of the mandible. Aspiration yielded characteristic keratinaceous material, and histopathological examination confirmed the diagnosis of an odontogenic keratocyst. The patient underwent complete enucleation of the lesion with peripheral ostectomy, extraction of tooth 46, and chemical cauterization using Carnoy's solution under general anesthesia. The residual cavity was thoroughly irrigated and managed with an open dressing technique using ribbon gauze coated with topical 5-fluorouracil. Subsequent alternate-day dressing changes were performed with ribbon gauze impregnated with povidone-iodine, tetracycline, and rifampicin until satisfactory secondary healing was achieved. Results: The postoperative period was uneventful except for mild transient inferior alveolar nerve paresthesia, which improved progressively with neurotrophic medication during follow-up. At the three-month review, the patient demonstrated excellent soft tissue healing with marked radiographic bone regeneration throughout the surgical cavity and no clinical or radiographic evidence of recurrence. Conclusion: Conservative management of a large mandibular odontogenic keratocyst using enucleation, peripheral ostectomy, Carnoy's solution, and staged open cavity dressing with topical 5-fluorouracil followed by antimicrobial dressings resulted in favorable wound healing, spontaneous bone regeneration, preservation of mandibular continuity, and recovery of neurosensory function. This treatment protocol appears to be an effective and minimally morbid option for selected cases; however, long-term clinical and radiographic follow-up is mandatory because of the inherent recurrence potential of odontogenic keratocysts.
Keywords: Odontogenic keratocyst, Enucleation, Peripheral ostectomy, 5-Fluorouracil, Carnoy's solution, Open dressing, Bone regeneration, Mandible, Conservative management, Case report
How to Cite?: Dr. Jamema Jamal, Dr. Nandesh K Shetty, Dr. Prasuna S, "Open Dressing as an Adjunct to Enucleation with Chemical Cauterization and Peripheral Ostectomy in the Management of Mandibular Odontogenic Keratocyst: A Case Report", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 114-118, https://www.ijsr.net/getabstract.php?paperid=SR26701122400, DOI: https://dx.doi.org/10.21275/SR26701122400