358 - Topical 5-Fluorouracil is Effective in Young Patients with Odontogenic Keratocysts

Abstract:

Purpose:
The odontogenic keratocyst (OKC) is an aggressive cyst with high recurrence rates. Although various chemotherapeutic agents have been used, there are no standardized treatment guidelines for pediatric or young adult patients. This study evaluated the safety and efficacy of topical 5-fluorouracil (5-FU) in pediatric and young adult patients with OKCs.



Methods:
An IRB-approved retrospective search of OKCs was conducted using electronic health records from the Stony Brook School of Dental Medicine and Stony Brook University Hospital (2019–2025). Patients older than 26 years of age or who did not receive topical 5-FU were excluded. Data collected included age, sex, medical history, symptoms, clinical and radiographic findings, treatment details, recurrences, and follow-ups. The data was analyzed qualitatively and descriptively.



Results:
Seven patients met the inclusion criteria (ages 11–23 years; 71% male, 29% female). One patient with Gorlin-Goltz syndrome (GGS) was treated with curettage, ostectomy, and 5-FU application. Non-syndromic patients underwent similar treatment with additional cyst decompression. The GGS patient experienced multiple postoperative complications including transient trismus, facial asymmetry, transient mental nerve hypoesthesia, and possible OKC recurrence. Non-syndromic patients had fewer complications: transient trismus (1/6), acute sinusitis (1/6), and transient dysgeusia (1/6). Panoramic radiographs demonstrated proper bone healing in all non-syndromic patients.





Conclusion:
Topical 5-FU is a safe and effective treatment that reduces recurrence and promotes bone healing in non-syndromic pediatric and young adult patients presenting with OKCs. Case series with a larger sample size or long-term randomized controlled trials should be conducted to further elucidate these findings.