Carnoys solutions as adjuvant therapy to fix and kill a remnant epithelial cells ,daughter cyst and microcysts as chemical cauterization agent . Some surgeons used it preoperatively whereas others use it postsurgically over surgical site.
Carnoys solution should be applied post-enucleation to fix and kill the remnant epithelial cells to prevent recurrence of KCOTs.
I am aware of and agree absolutely with post-enucelation application for a space of about 3 minutes. I honestly cannot figure out how and why a pre-enucleation application is expected to work. Can you supply reference(s) on pre-enucleation application please? Thank you.
Voorsmit RA, Stollinga PT, Van Hallst VJ. The management of keratocysts. J Maxillofac Surg 1981;9:228-36.
Dear Essam A. Al-Moraissi,
The components of Carnoy’s solution are absolute alcohol 6ml, chloroform 3ml, glacial acetic acid 1ml, ferric chloride 1gm. It is a tissue fixative that penetrates bone to a depth of 1.54 mm. It should be applied post enucleation to fix and kill the remnants of epithelial cells as well as to prevent recurrence of the lesion.
Dear Dr Essam A. Al-Moraissi,
Carnoy’s solution described by Voorsmit (1981) is a chemical formula that has a tissue-fixation property used in histology and a tissue cauterization property utilized in chemical curettage.
Now the interesting part: 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”
Coming to your question I would like to add…The rationale for using Carnoy’s solution is similar to that of cryosurgery. The goal of both techniques was to kill epithelial remnants and dental lamina in the osseous margin.
Dear Essam, Thanks for sharing a reference on this interesting subject. I got the article by Voorsmit RA et al. and have read through it (attached). That was a great job. The authors from my point of view do not seem to imply a pre-enucleation use of Carnoy's solution and that allays my worry. In my opinion, pre-enucleation application will not be feasible for the following reasons:
Carnoy’s solution has moderate penetration; so if applied before enucleation, it would probably, barely go beyond the cyst lining. So why apply it to a lining that is coming out at enucleation?
Carnoy’s solution has a rapid local fixation property, there should therefore be no use in applying it to a cyst lining that is accessible, and that can and will eventually be removed easily.
Its prolonged/ generous use is not advisable in lieu of the fact that it acts rapidly, and contains chloroform (?carcinogen) .
These suggest that post enucleation application of Carnoy’s solution is preferred. However, possibly on rare occasions (e.g where cyst lining is not readily accessible) pre-enucleation application may help fix the cells and limit spillage from a typically friable thin lining during enucleation. Just my thoughts!!!
Article The Management of Keratocysts
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