Adjunctive topical 5-fluorouracil for reducing recurrence in conservative surgical treatment of ameloblastoma: a STROBE-compliant retrospective cohort study

The present study aimed to evaluate the efficacy of adjunctive topical 5-fluorouracil in reducing recurrence following conservative surgical management of ameloblastomas (enucleation, curettage, with or without peripheral ostectomy). A secondary objective was to assess the incidence of long-term inferior alveolar nerve injury. This retrospective matched cohort study enrolled 23 patients who were treated conservatively for histopathologically confirmed ameloblastoma with adjunctive topical 5-fluorouracil between January 2015 and June 2023, of whom 17 were included in the final analysis. Surgical procedures consisted of enucleation and/or curettage, with 5% 5-fluorouracil-soaked gauze applied intraoperatively for 24 h. Follow-up involved clinical and radiographic evaluations for a minimum of 24 months. Long-term nerve injury was defined as hypoesthesia or neuropathic pain persisting for ≥ 12 months. Most lesions were unilocular (76.5%) and histologically follicular. Enucleation with peripheral ostectomy was performed in 52.9% of cases. Mean follow-up was 73.9 ± 24.2 months (36–118 months). Recurrence occurred in one patient (5.9%), yielding a 94.1% cumulative recurrence-free survival and mean recurrence-free survival of 112.7 ± 5.2 months. Temporary inferior alveolar nerve paresthesia occurred in 2 patients (11.8%) and resolving within 4 to 6 weeks, with no permanent nerve injuries. The significance level was set at p < 0.05. Adjunctive topical 5-fluorouracil in conjunction with conservative surgery appears to be both safe and effective in reducing recurrence while preserving nerve function. However, long-term studies are needed to further evaluate its efficacy in minimizing recurrence and associated morbidity in patients with ameloblastoma. The use of adjunctive topical 5-fluorouracil in the conservative surgical management of ameloblastomas may assist clinicians in developing more effective strategies for preventing recurrence while minimizing patient morbidity.