Gas Combination Cryotherapy as an Adjuvant in the Management of Benign Odontogenic Jaw Lesions: A Prospective Clinical Study

Gas Combination Cryotherapy as an Adjuvant in the Management of Benign Odontogenic Jaw Lesions: A Prospective Clinical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gas Combination Cryotherapy as an Adjuvant in the Management of Benign Odontogenic Jaw Lesions: A Prospective Clinical Study Shyam Chauhan, Shital Patel, Zenish Bhatti, Yasashvi Chavda, Neha Parmar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8448215/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Benign odontogenic lesions, including odontogenic keratocyst, ameloblastoma, and adenomatoid odontogenic tumor, are locally aggressive jaw lesions with a high risk of recurrence. Their management ranges from conservative procedures to radical resections, but countering recurrence still remains a challenge. Various adjuvants such as chemical cauterizing agents like Carnoy’s solution and thermal methods including cryotherapy have been utilized to reduce recurrence rate. Hence, present study was aimed to evaluate the management outcome for benign odontogenic lesions having high recurrence rate following usage of gas combination cryotherapy as an adjunct. Methods Thirty-three patients aged 20–50 years having benign odontogenic lesions with high recurrence rate were included. Patients with lesion recurrence following previous surgery were excluded. Lesion dimensions, bone density and volume were measured pre- and postoperatively using cone-beam computed tomography. Incidence of neurosensory disturbances, pathological fracture and recurrence too were noted. Wilcoxon signed-rank test was used to evaluate lesion size and volume, paired t-test for bone density, and Cochran’s Q-test for neurosensory outcomes, with significance set at P ≤ 0.05. Results Results showed a significant 91.83% overall reduction in lesion volume, with maxillary and mandibular lesions reducing by 83.15% and 94.05%, respectively ( P < 0.001). Bone density improved significantly from 189.80 to 480.50 Hounsfield Units, indicating considerable bone regeneration ( P < 0.001). The treatment was well tolerated with minimal complications and no recurrence observed during entire follow-up. Conclusion These findings suggest GCC is a safe and effective adjunctive treatment to enhance bone healing and reduce recurrence rates in aggressive benign odontogenic lesions of the jaw. odontogenic cyst odontogenic tumour cryotherapy adjuvant therapy bone regeneration Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Maxillofacial benign odontogenic lesions like odontogenic keratocyst (OKC), ameloblastoma, and adenomatoid odontogenic tumor (AOT) often exhibit locally aggressive behaviour with a recurrence rate ranging from 25% to 60%, especially following conservative management. [ 1 , 2 ] Management strategies range from conservative approaches (marsupialization, decompression, enucleation, curettage, excision) to radical procedures (resection). Conservative treatment alone often results in incomplete removal of epithelial remnants or satellite cysts, predisposing to recurrence. Although radical surgery offers a lower recurrence risk, it may result in substantial morbidity and functional impairment. [ 3 ] Various adjuvant therapies including chemical agents like Carnoy’s solution and 5-fluorouracil as well as thermal modalities like cryotherapy and electrocauterization are employed with conservative approaches to target residual epithelial cells and satellite cysts within the adjacent cancellous bone. [ 2 ] The efficacy of Carnoy’s solution, previously considered as the gold standard adjuvant, may have declined due to the elimination of chloroform, because of its carcinogenic potential. Electrocautery carries risks of thermal injury and aerosol generation. [ 4 , 5 ] Cryotherapy, with liquid nitrogen, utilizes temperatures as low as -196°C. Temperatures below − 20°C induce cell death due to formation of intracellular and extracellular ice crystals, along with osmotic and electrolyte imbalances. At the same time, it maintains the inorganic osseous architecture, which facilitates new bone formation. However, freezing the full thickness of the mandible can lead to delayed healing and increase the risk of pathologic fractures. [ 3 ] To address these limitations, gas combination cryotherapy (GCC), which is a combination of propane (30–50%), butane (30–50%), and isobutane (10–20%), has emerged as a promising alternative. It employs a temperature of − 50°C, which causes cell lysis while preserving inorganic bone, thereby reducing the risk of pathological fracture of the jaw. GCC is commercially available in a spray formulation, which enables ease of handling and precise application within the cavity, thereby facilitating better control and reducing the risk of injury to adjacent soft tissues. [ 6 ] Hence, the aim of present study was to evaluate the efficacy of GCC as an adjuvant therapy in the management of benign odontogenic lesions of the jaw. The primary objectives were to assess the extent of bone regeneration, changes in bone density, and recurrence of lesion. Secondary objectives included evaluating postoperative wound healing, such as the presence of wound dehiscence or infection, neurosensory function, vitality of adjacent teeth, and incidence of pathologic fracture. Material and methods Study Design: This prospective clinical study was conducted at the Oral and Maxillofacial Surgery Department, AMC Dental College and Hospital, Ahmedabad, India, from January 2023 to November 2025. Study objectives, surgical procedure, possible adverse events, and associated risks and benefits were thoroughly explained to all the patients beforehand. Duly signed informed consent regarding the publication of their data, radiographs, and clinical photographs was obtained. Prior ethical approval was obtained from the Institutional Ethics Committee (AMC/IEC/OS/PG75/23), and the study was conducted in accordance with guidelines provided by the World Medical Association’s Declaration of Helsinki (1964) and its Seventh Amendment (2013). All patients aged 20–50 years falling into the American Society of Anesthesiologists (ASA) class I category, having benign odontogenic lesions of high recurrence potential, diagnosed through pre-operative incisional biopsy and requiring surgical intervention, were included in this study. Patients with extensive thinning and perforation of cortical bone plates where peripheral ostectomy can lead to pathological fractures, history of radiation or chemotherapy, medical comorbidities, recurrent jaw lesions requiring resection, bone diseases like rheumatoid arthritis and osteomyelitis of the jaw, drugs affecting bone healing like bisphosphonates and methotrexate, pregnant or lactating women, patients taking oral contraceptives, and patients having a habit of smoking or alcohol consumption were excluded from the study. All patients underwent preoperative diagnostic imaging with orthopantomogram (OPG) and cone-beam computed tomography (CBCT) to evaluate the size, volume, and radiodensity of the lesion. Additionally, preoperative assessment was done to evaluate the vitality of involved teeth and the presence of any pre-existing neurosensory deficits or pathologic fractures. Surgical Procedure: Surgical procedures were performed under general anesthesia under strict aseptic conditions by the same surgeon. A standardized surgical protocol was followed for all patients. Local anesthesia was administered at the site of planned incision. Based on the location and extent of the lesion, a full-thickness mucoperiosteal flap was raised. Carious, impacted, mobile, non-vital and teeth with root resorption were extracted. After exposure, enucleation or complete excision of the lesion was carried out and residual bony cavity was thoroughly irrigated with 5% povidone-iodine, hydrogen peroxide (H₂O₂) and 0.9% sterile normal saline. Peripheral ostectomy was performed using a large round carbide bur under copious normal saline irrigation. Haemostasias was achieved, and the surrounding soft and hard tissues were protected using tongue depressors and gauze soaked in petroleum jelly. In cases where the nerve was exposed within the residual bony cavity, it was gently protected using sterile petroleum jelly-soaked gauze to prevent direct mechanical or thermal injury. GCC (combination of propane, butane, and isobutane gas (Endo-Frost, Roeko, Langenau, Germany) (Fig. 1 ) was then administered by spraying the residual cavity for 1 minute, followed by a thawing period of 1 minute. Three freeze–thaw cycles were then applied consecutively. Surrounding tissues were irrigated with normal saline immediately after this to minimise the risk of thermal injury. Finally, the flap was repositioned, and the surgical site was closed primarily. (Fig. 2 ) Data Collection: The size of the lesion was assessed by measuring the greatest anteroposterior (AP), buccolingual (BL), and superoinferior (SI) dimensions of the defect preoperatively and postoperatively at 12 months using CBCT. The difference between these measurements was used to evaluate the extent of bone regeneration. (Fig. 3 ) The volume of the lesion was estimated using the two greatest dimensions obtained from CBCT scans. This provided an approximate assessment of lesion size preoperatively and postoperatively, aiding in the evaluation of bone regeneration over the 12-month follow-up period. Volume of lesion was measured using the following formula: D1 and D2 are the largest dimensions of the lesion in two planes in cm, and K is a constant with a value of 2.53. [ 7 ] Preoperative lesion radiodensity was assessed using CBCT imaging and recorded in Hounsfield Units (HU). Bone density was again assessed at 12 months follow-up. The change in HU values over time was used to infer the nature and quality of bone regeneration. Neurosensory function was assessed both preoperatively and postoperatively at defined intervals of 1 week, 1 month, 3 months, 6 months, and 12 months, using both subjective and objective methods. Subjective evaluation involved questioning the patient regarding the presence of tingling, numbness, altered sensations, or complete loss of sensation in the affected region. Objective assessment involved evaluating the patient’s response to pinprick stimuli with a blunt dental explorer, applied alternately to the contralateral, unaffected side. Tactile discrimination was assessed by determining whether the patient could accurately differentiate between the two stimuli, thereby monitoring the presence/absence and progression/regression of any neurosensory deficits. The surgical site was evaluated for gingival healing using Landry’s Healing Index. Signs of infection and wound dehiscence were recorded on the 1st, 3rd, and 7th postoperative days. In addition to clinical examination of surgical site, recurrence of the lesion and occurrence of any pathological fracture were assessed radiographically too at 6 months, 1 year and 3 years. Statistical Analyses Sample size was calculated using the following formula, keeping the power of the test at 80% and the level of significance at 5%. Statistical analysis was carried out using SPSS (Statistical Package for Social Sciences) 20.0, IBM, India software. Mean ± SD was used for continuous variables, while numbers and percentages were used for categorical variables. The Wilcoxon signed rank test was used to analyse the reduction in the mean lesion size, mean bone formation and mean volume of lesion. Paired t-test was used to analyse mean lesion density, and Cochran’s Q-test was used to analyse neurosensory alterations. P- value ≤ 0.05 was considered statistically significant. Results A total of 41eligible patients were screened initially. Of these, 5 patients were excluded due to presence of lesion with a rare likelihood of recurrence, specifically dentigerous cyst, nasopalatine duct cyst and radicular cyst. An additional 3 patients were excluded as they lost follow-up during study period. The final study sample consisted of 33 subjects (22 males, 11 females), aged between 20–50 years, with a mean age of 32.09 ± 7.2 years. The mean age of males was 32.5 ± 7.26 years, and that of females was 31.27 ± 7.36 years. (Table 1 ) Table 1 Characteristics of the study sample Demographic Variables Number of patients, n (%) 33 (100) Age (years), mean ± SD 32.09 ± 7.2 Sex, n (%) female 11 (33.33) male 22 (66.67) Distribution of Lesion in jaw, n (%) Mandible 24 (72.73) Body 12 (37) Angle 8 (24) Parasymphysis 2 (6) Ramus 2 (6) Maxilla 9 (27.27) Anterior 6 (18) Posterior 3 (6) Distribution as per Histopathological diagnosis, n (%) OKC 15 (39.39) Ameloblastoma 10 (21.21) Cemento ossifying fibroma 2 (9.09) Odontogenic myxoma 3 (6.06) AOT 3 (6.06) OKC, orthokeretinized odontogenic keretocyst; AOT, adenomatoid odontogenic tumour When reduction in the mean lesion size was calculated, the mean preoperative dimensions in SI, AP, and BL planes were 37.12 ± 8.22 mm, 29.03 ± 9.27 mm, and 17.94 ± 8.33 mm, respectively, which reduced postoperatively at 12 months to 6.94 ± 9.84 mm, 4.48 ± 5.58 mm, and 3.27 ± 3.98 mm. A statistically significant reduction in the mean lesion size was observed postoperatively using the Wilcoxon signed rank test. ( P < 0.001). (Table 2 ) Table 2 Change in the size of lesion over 12 months interval, in millimetres. Dimension Direction Time Interval Mandible (mean ± SD) Maxilla (mean ± SD) Overall (mean ± SD) P- value* a SI Preoperative 38.47 ± 7.4 33. 51 ± 9.61 37.12 ± 8.22 0.001 Postoperative 5.5 ± 7.58 10.65 ± 14.17 6.94 ± 9.84 0.001 AP Preoperative 28.48 ± 8.82 30.47 ± 10.81 29.03 ± 9.27 0.001 Postoperative 4.05 ± 5.62 5.61 ± 4.48 4.48 ± 5.58 0.001 BL Preoperative 14.64 ± 5.04 9.21 ± 17.94 17.94 ± 8.33 0.001 Postoperative 2.76 ± 3.74 4.51 ± 3.27 3.21 ± 3.98 0.001 SI, superoinferior; AP, anteroposterior; BL, buccolingual; SD; standard deviation * P ≤ 0.05, considered statistically significant a Wilcoxon Signed Rank Test Correspondingly, the mean bone formation was 28.38 ± 10.68 mm (78.6%) in SI, 22.54 ± 9.66 mm (81.64%) in AP, and 12.18 ± 9.53 mm (74.56%) in BL, with the greatest regeneration observed in the anteroposterior plane at 12 months. A statistically significant reduction in size was noted using Wilcoxon signed rank test. ( P < 0.001). (Table 2 ) The mean volume of lesion showed a reduction of 83.15% in the maxilla and 94.05% in the mandible, with an overall reduction of 91.83% in all lesions from the pre- to post-operative at 12 months evaluation, representing a statistically significant reduction using the Wilcoxon signed rank test. ( P < 0.001). (Table 3 ) Table 3 Change in the volume of lesion, in millilitres and density, in Hounsfield units over 12 months. Parameter Time interval Mandible (mean ± SD) Maxilla (mean ± SD) Overall (mean ± SD) P - value * Volume Preoperative 4.52 (2.38) 4.46 (2.53) 4.50 (2.38) 0.001 a Postoperative 0.24 (0.34) 0.36 (0.41) 0.27 (0.36) 0.001 a Volume reduction (%) 94.05 (8.85) 83.15 (8.85) 91.83 (12.3) 0.001 a Bone Density (HU) Preoperative 480.5 0.001 b Postoperative 189.8 HU; Hounsfield unit * P ≤ 0.05, considered statistically significant a Wilcoxon Signed Rank Test b Paired t-test Additionally, the mean lesion density increased significantly from 189.80 Hounsfield Units (HU) preoperatively to 480.50 HU at 12 months postoperatively using Paired t-test ( P < 0.001). (Table 3 ) Neurosensory alterations, comprising of subjective (numbness and altered sensation) and objective changes (pin-prick test), were observed in 20 patients (60.6%) immediate postoperatively which persisted up to 3 months. The incidence decreased to 2 patients (6.1%) at 6 months, with only one patient (3%) exhibiting residual deficits at the 12-month follow-up. Tingling sensation was reported in 18 patients (54.54%) at 3 months follow-up, reduced to 2 patients (6.1%) at 6-month follow-up, and resolved completely by the 1-year follow-up, showing a statistically significant improvement using Cochran’s Q-test ( P < 0.001). (Table 4 ) Table 4 Neurosensory deficit assessment. Paraesthesia Pre-op Post-op 3rd Month 6th Month 1 Year P -value * a Numbness & absence of Sensation-Present 1 20 20 2 1 < 0.001 Altered Sensation-Present 1 20 20 2 1 < 0.001 Tingling-Present 0 0 18 2 0 < 0.001 Pin Prick Test-Present 1 20 20 2 1 < 0.001 * P ≤ 0.05, considered statistically significant a Cochran’s Q-test When wound healing was assessed, it showed marked hyperaemia without ulceration within first 72 hours. All patients exhibited uneventful wound healing with complete wound epithelialization by 2 weeks postoperatively. None of the patients showed signs of postoperative wound infection. However, wound dehiscence with underlying bone exposure was observed in 2 (6.06%) patients on 7th postoperative day, which later healed by secondary intention within 2 weeks. One patient (3.03%) developed a pathological jaw fracture at the 3-month follow-up. None of the lesions showed any clinical or radiographic evidence of recurrence during the entire follow-up period. (Table 5 ) Table 5 Incidence of complications Parameter (n = 33) n (%) Wound dehiscence 2 (6.06) Pathologic fracture 1 (3.03) Recurrence 0 (0) Descriptive analyses Discussion Management of benign odontogenic lesion of jaws depends on patient’s age, size, location and type of lesion, soft tissue involvement, previous treatments, histological variant and becomes further challenging owing to higher recurrence potential and local bone destruction. [ 8 ] Surgical management typically primarily involves enucleation, excision or curettage, but it is often insufficient to eliminate epithelial remnants or satellite cysts, which are responsible for its recurrence. [ 9 ] Hence, lesions with higher recurrence potential often require a more aggressive yet conservative approach, combining the above management strategies with adjuvant therapies like electro-, chemical, or thermal cauterization or mechanical techniques like peripheral ostectomy for their management. Chemical cauterization with Carnoy’s solution is considered the gold standard, primarily due to its ability to fixate and destroy residual cystic epithelium. However, a major limitation arose when chloroform - one of its key constituents was banned by the U.S. FDA in 1992. Its exclusion thereby reduced the solution’s efficacy and prompted the search for an ideal alternative adjuvant. [ 4 ] Cryosurgery, using liquid nitrogen serving as a cauterizing agent, was first described by Ralph C. Marcove in 1968 for the treatment of primary and metastatic bone tumors. [ 3 , 10 ] Living tissues freeze at approximately − 2.2°C, and temperatures below − 20°C are considered lethal to cells. [ 11 ] Liquid nitrogen achieves temperatures as low as − 196°C, inducing cell death through intracellular and extracellular ice crystal formation, osmotic and electrolyte imbalance, while preserving the inorganic bone matrix [ 13 , 14 ]. Its depth of penetration into bone (0.51–1.52 mm) is comparable to Carnoy’s solution (≈ 1.54 mm). [ 14 ] Most protocols advocate rapid freezing to promote intracellular ice crystal formation, followed by slow thawing to induce electrolyte imbalance, thereby maximizing cytotoxicity. [ 3 ] However, excessive freezing of bone during cryotherapy can impair the osteogenic response, especially when adjacent soft tissues are severely damaged. In such cases, bone resorption surpasses osteogenesis and weakens the bone, leading to an increased risk of pathological fractures. Therefore, maintaining an optimal temperature range is critical to prevent adverse effects. [ 13 ] Additional limitations of conventional liquid nitrogen cryotherapy include difficulties in handling large apparatus containing the agent within the bony cavity and ensuring its sterility. [ 15 ] GCC has emerged as an alternative to liquid nitrogen, achieving temperatures around − 50°C sufficient for cell lysis but not as extreme as − 196°C achieved through conventional cryotherapy [ 12 ]. This controlled temperature provides effective cytotoxicity while minimizing structural bone damage and reduces the risk of pathological fracture. [ 14 ] An additional advantage of GCC is its ease of delivery via calibrated spray through fine nozzle, allowing easier handling, precise application, better control and reduced risk of injury to adjacent soft tissues. [ 15 ] GCC destroys tissue by rapid freezing and slow thawing, causing membrane disruption, protein denaturation and microvascular damage leading to ischemic necrosis. (Fig. 4 ) Subsequent inflammatory response clears necrotic debris and healing occurs by secondary intention. [ 16 ] A GCC protocol similar to that used by Anjali et al. [ 14 ] for their 10 cases of OKC was adopted in the present study, wherein enucleation/excision followed by peripheral ostectomy and 3 cycles of 1-minute GCC application with an intervening 1-minute thawing period after each cycle were carried out. However, it differs from the protocol used by Carneiro et al. and Cruz et al., who performed marsupialization followed by enucleation and a single 1-minute GCC application in 10 cases of ameloblastoma and 10 cases of keratocystic odontogenic tumour respectively. [ 6 , 15 ] During first 72 hours postoperatively, tissues surrounding the surgical area demonstrated pronounced hyperemia without evidence of ulceration, indicative of normal inflammatory response. Present study demonstrated uneventful wound healing proceeding in all patients with complete epithelialization and tissue repair by the end of approximately 2 weeks. However, postoperative wound dehiscence was observed in 2 patients (lesions size > 4 cm) within the first week characterized by partial exposure of the underlying bony cavity, suggestive of lesion size being a probable contributory factor. Dehiscence was successfully managed through copious wound irrigation using 0.2% chlorhexidine, physiological saline solution, topical antibiotic application, and strict oral hygiene maintenance. Neither of the cases required extended systemic antibiotic therapy as there were no clinical signs of infection. In contrast, Carneiro et al. [ 6 ] and Cruz et al. [ 15 ] observed wound dehiscence in all of their patients. The lower incidence of wound dehiscence in the present study can be attributed to meticulous wound protection with petroleum jelly-soaked gauze and strict adherence to the standardized GCC and asepsis protocol. In one case of parakeretinized odontogenic keretocyst, a pathological fracture was noted at 3 months postoperatively at mandibular body region which was successfully managed with open reduction and internal fixation. This was corresponding to an area with a critically thin residual bone of approximately 1.6 mm at the lower border. Although rare, this emphasizes the need to assess residual bone height preoperatively to mitigate fracture risk. Carneiro et al. [ 6 ] and Cruz et al. [ 15 ] observed no pathological fractures which might be due to differences in lesion size, anatomical involvement, and selected treatment protocol. Importantly, no recurrence was detected during the entire follow-up period of 3 years with a mean follow-up period of 18.3 months. While this supports the efficacy of GCC as an adjuvant in preventing recurrences of odontogenic lesions, a longer follow-up period is still being advocated. Carneiro et al. [ 17 ], Cruz et al. [ 15 ] and Anjali et al. [ 14 ] also observed no cases of recurrence in their study during a mean follow-up period of 70.55 months, 64.3 months, and 15 months, respectively. Overall, GCC offered several advantages over conventional adjuvants such as ease of handling, adequate penetration depth, and reduced risk of collateral damage to adjacent bone, soft tissues and neural as well as vascular structures. The encouraging clinical, radiographic, and neurosensory outcomes in our study reinforce GCC as a biocompatible, safe and effective adjunct in the management of benign odontogenic jaw lesions. Relatively small sample size, limited follow-up period, and fewer varieties of benign odontogenic lesions having higher recurrence potential are certain limitations of our study. Since recurrence of odontogenic lesions may manifest several years after treatment, long-term prospective studies with larger cohorts are required to validate the durability of these outcomes. Furthermore, comparative trials evaluating GCC directly against other adjuvant modalities such as modified Carnoy’s solution or liquid nitrogen would provide stronger evidence regarding its relative efficacy and safety. Future research should also focus on optimizing cryotherapy protocols, assessing long-term functional outcomes, and exploring adjunctive regenerative techniques to enhance bone healing in large residual defects. Declarations Funding The authors declare that no funds, grants, or the other support were received for this study. Competing Interest Declared none. Ethical Approval This study was performed in line with the principles of the Declaration of Helsinki. Prior ethical approval was obtained from the Institutional Ethics Committee (AMC/IEC/OS/PG75/23) of AMC Dental College and Hospital, Ahmedabad, India. Clinical Trial Registration: Not Applicable Consent to participate Informed consent was obtained from all individual participants included in this study. Consent for publication The authors affirms that all human research participants provided informed consent for publication of the images in the figure 2. Authors contribution Shyam Chauhan and Shital Patel contributed equally towards conceptualization, designing, implementation and manuscript drafting. Zenish Bhatti contributed to data organization, interpretation and reviewing the manuscript for its intellectual content. Yasashvi Chavda, Neha Parmar and Shivam Kukadiya contributed in data collection and organization for the study. All authors have reviewed the manuscript before submission. References Gohel A, Villa A, Sakai O (2016) Benign jaw lesions. Dent Clin 60(1):125–141 Vallejo-Rosero KA, Camolesi GV, de Sá PL, Bernaola-Paredes WE (2020) Conservative management of odontogenic keratocyst with long-term 5 year follow-up: Case report and literature review. Int J Surg Case Rep 66:8–15 Pogrel MA (1993) The use of liquid nitrogen cryotherapy in the management of locally aggressive bone lesions. J Oral Maxillofac Surg 51(3):269–273 Lal B, Kumar RD, Alagarsamy R, Sundaram DS, Bhutia O, Roychoudhury A (2021) Role of Carnoy's solution as treatment adjunct in jaw lesions other than odontogenic keratocyst: a systematic review. Br J Oral Maxillofac Surg 59(7):729–741 Kiran DN, Bali A, Anupama A, Electro-Cauterization A (2014) Good Adjunctive Therapy To Treat Kcot's. Indian J Dent Sci. ;6(4) Carneiro JT, Couto AP, Carreira AS (2012) Use of gas combination cryosurgery for treating ameloblastomas of the jaw. 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J Cranio-Maxillofacial Surg 42(5):423–427 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8448215","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571668329,"identity":"ab30c9d3-dd00-408a-a963-25805729e92a","order_by":0,"name":"Shyam Chauhan","email":"","orcid":"","institution":"AMC Dental College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shyam","middleName":"","lastName":"Chauhan","suffix":""},{"id":571668330,"identity":"b2701577-b11b-4296-b210-73b8a24daa83","order_by":1,"name":"Shital Patel","email":"","orcid":"","institution":"AMC Dental College and 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07:45:08","extension":"html","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107132,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8448215/v1/99f44b0581af0e51a165099b.html"},{"id":100013239,"identity":"f43a089a-59c1-411d-b9a3-95b3caa020a4","added_by":"auto","created_at":"2026-01-12 06:19:24","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34812,"visible":true,"origin":"","legend":"\u003cp\u003eGas combination cryotherapy agent, a combination of propane, butane, and isobutane gas (Endo-Frost, Roeko, Langenau, Germany).\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8448215/v1/dddb6d701a245a334f98efaa.jpg"},{"id":100013245,"identity":"3a40f4e1-e0c8-4ed5-8b60-a332f4bb3c5c","added_by":"auto","created_at":"2026-01-12 06:19:24","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":222889,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical management of OKC; (a) pre-operative site of lesion\u003cstrong\u003e \u003c/strong\u003e(b) residual cavity after enucleation. (C) application of gas combination cryotherapy and protection of adjacent soft tissue with gauze soaked in petroleum jelly (d) frosting on residual bony cavity walls (f) primary closure of wound (g) Wound healing at 3 months follow up.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8448215/v1/0d4aa1a54df07c7d1cd09c6c.jpg"},{"id":100013248,"identity":"2b93489f-83e3-40c6-a1bf-d3c1fc616ecb","added_by":"auto","created_at":"2026-01-12 06:19:24","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":181716,"visible":true,"origin":"","legend":"\u003cp\u003eRadiographic assessment of lesion; (a) pre-operative OPG, (b) greatest pre-operative anterio-posterior and bucco-lingual dimensions, (c) greatest pre-operative supero-inferior and bucco-lingual dimensions, (d) Post-operative OPG, (e) greatest post-operative anterio-posterior and bucco-lingual dimensions, (f) greatest supero-inferior and bucco-lingual dimensions of residual bony cavity at 12 months follow up.\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8448215/v1/f604ffea764e9beac25ec56a.jpg"},{"id":100013242,"identity":"5225478f-7c52-4160-bf86-f36bfd3ce8aa","added_by":"auto","created_at":"2026-01-12 06:19:24","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":101512,"visible":true,"origin":"","legend":"\u003cp\u003ePhases of healing of bone secondary to gas combination cryotherapy.\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8448215/v1/9e58127e754b47c70c8b40dc.jpg"},{"id":102310205,"identity":"203ea8b3-67e9-4961-a859-8f1b8da3e7bf","added_by":"auto","created_at":"2026-02-10 11:52:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1238008,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8448215/v1/9178c4a5-079b-463a-8257-652ac09e06ab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gas Combination Cryotherapy as an Adjuvant in the Management of Benign Odontogenic Jaw Lesions: A Prospective Clinical Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMaxillofacial benign odontogenic lesions like odontogenic keratocyst (OKC), ameloblastoma, and adenomatoid odontogenic tumor (AOT) often exhibit locally aggressive behaviour with a recurrence rate ranging from 25% to 60%, especially following conservative management. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eManagement strategies range from conservative approaches (marsupialization, decompression, enucleation, curettage, excision) to radical procedures (resection). Conservative treatment alone often results in incomplete removal of epithelial remnants or satellite cysts, predisposing to recurrence. Although radical surgery offers a lower recurrence risk, it may result in substantial morbidity and functional impairment. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eVarious adjuvant therapies including chemical agents like Carnoy\u0026rsquo;s solution and 5-fluorouracil as well as thermal modalities like cryotherapy and electrocauterization are employed with conservative approaches to target residual epithelial cells and satellite cysts within the adjacent cancellous bone. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] The efficacy of Carnoy\u0026rsquo;s solution, previously considered as the gold standard adjuvant, may have declined due to the elimination of chloroform, because of its carcinogenic potential. Electrocautery carries risks of thermal injury and aerosol generation. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Cryotherapy, with liquid nitrogen, utilizes temperatures as low as -196\u0026deg;C. Temperatures below \u0026minus;\u0026thinsp;20\u0026deg;C induce cell death due to formation of intracellular and extracellular ice crystals, along with osmotic and electrolyte imbalances. At the same time, it maintains the inorganic osseous architecture, which facilitates new bone formation. However, freezing the full thickness of the mandible can lead to delayed healing and increase the risk of pathologic fractures. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo address these limitations, gas combination cryotherapy (GCC), which is a combination of propane (30\u0026ndash;50%), butane (30\u0026ndash;50%), and isobutane (10\u0026ndash;20%), has emerged as a promising alternative. It employs a temperature of \u0026minus;\u0026thinsp;50\u0026deg;C, which causes cell lysis while preserving inorganic bone, thereby reducing the risk of pathological fracture of the jaw. GCC is commercially available in a spray formulation, which enables ease of handling and precise application within the cavity, thereby facilitating better control and reducing the risk of injury to adjacent soft tissues. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHence, the aim of present study was to evaluate the efficacy of GCC as an adjuvant therapy in the management of benign odontogenic lesions of the jaw. The primary objectives were to assess the extent of bone regeneration, changes in bone density, and recurrence of lesion. Secondary objectives included evaluating postoperative wound healing, such as the presence of wound dehiscence or infection, neurosensory function, vitality of adjacent teeth, and incidence of pathologic fracture.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003e This prospective clinical study was conducted at the Oral and Maxillofacial Surgery Department, AMC Dental College and Hospital, Ahmedabad, India, from January 2023 to November 2025. Study objectives, surgical procedure, possible adverse events, and associated risks and benefits were thoroughly explained to all the patients beforehand. Duly signed informed consent regarding the publication of their data, radiographs, and clinical photographs was obtained. Prior ethical approval was obtained from the Institutional Ethics Committee (AMC/IEC/OS/PG75/23), and the study was conducted in accordance with guidelines provided by the World Medical Association\u0026rsquo;s Declaration of Helsinki (1964) and its Seventh Amendment (2013).\u003c/p\u003e \u003cp\u003eAll patients aged 20\u0026ndash;50 years falling into the American Society of Anesthesiologists (ASA) class I category, having benign odontogenic lesions of high recurrence potential, diagnosed through pre-operative incisional biopsy and requiring surgical intervention, were included in this study. Patients with extensive thinning and perforation of cortical bone plates where peripheral ostectomy can lead to pathological fractures, history of radiation or chemotherapy, medical comorbidities, recurrent jaw lesions requiring resection, bone diseases like rheumatoid arthritis and osteomyelitis of the jaw, drugs affecting bone healing like bisphosphonates and methotrexate, pregnant or lactating women, patients taking oral contraceptives, and patients having a habit of smoking or alcohol consumption were excluded from the study.\u003c/p\u003e \u003cp\u003eAll patients underwent preoperative diagnostic imaging with orthopantomogram (OPG) and cone-beam computed tomography (CBCT) to evaluate the size, volume, and radiodensity of the lesion. Additionally, preoperative assessment was done to evaluate the vitality of involved teeth and the presence of any pre-existing neurosensory deficits or pathologic fractures.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical Procedure:\u003c/h3\u003e\n\u003cp\u003eSurgical procedures were performed under general anesthesia under strict aseptic conditions by the same surgeon. A standardized surgical protocol was followed for all patients. Local anesthesia was administered at the site of planned incision. Based on the location and extent of the lesion, a full-thickness mucoperiosteal flap was raised. Carious, impacted, mobile, non-vital and teeth with root resorption were extracted.\u003c/p\u003e \u003cp\u003eAfter exposure, enucleation or complete excision of the lesion was carried out and residual bony cavity was thoroughly irrigated with 5% povidone-iodine, hydrogen peroxide (H₂O₂) and 0.9% sterile normal saline. Peripheral ostectomy was performed using a large round carbide bur under copious normal saline irrigation. Haemostasias was achieved, and the surrounding soft and hard tissues were protected using tongue depressors and gauze soaked in petroleum jelly. In cases where the nerve was exposed within the residual bony cavity, it was gently protected using sterile petroleum jelly-soaked gauze to prevent direct mechanical or thermal injury. GCC (combination of propane, butane, and isobutane gas (Endo-Frost, Roeko, Langenau, Germany) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was then administered by spraying the residual cavity for 1 minute, followed by a thawing period of 1 minute. Three freeze\u0026ndash;thaw cycles were then applied consecutively. Surrounding tissues were irrigated with normal saline immediately after this to minimise the risk of thermal injury. Finally, the flap was repositioned, and the surgical site was closed primarily. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \n\u003ch3\u003eData Collection:\u003c/h3\u003e\n\u003cp\u003eThe size of the lesion was assessed by measuring the greatest anteroposterior (AP), buccolingual (BL), and superoinferior (SI) dimensions of the defect preoperatively and postoperatively at 12 months using CBCT. The difference between these measurements was used to evaluate the extent of bone regeneration. (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe volume of the lesion was estimated using the two greatest dimensions obtained from CBCT scans. This provided an approximate assessment of lesion size preoperatively and postoperatively, aiding in the evaluation of bone regeneration over the 12-month follow-up period.\u003c/p\u003e \u003cp\u003eVolume of lesion was measured using the following formula:\u003c/p\u003e \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767969462.png\" style=\"width: 446px;\"\u003e\u003c/p\u003e\n\u003cp\u003eD1 and D2 are the largest dimensions of the lesion in two planes in cm, and K is a constant with a value of 2.53. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePreoperative lesion radiodensity was assessed using CBCT imaging and recorded in Hounsfield Units (HU). Bone density was again assessed at 12 months follow-up. The change in HU values over time was used to infer the nature and quality of bone regeneration.\u003c/p\u003e \u003cp\u003eNeurosensory function was assessed both preoperatively and postoperatively at defined intervals of 1 week, 1 month, 3 months, 6 months, and 12 months, using both subjective and objective methods. Subjective evaluation involved questioning the patient regarding the presence of tingling, numbness, altered sensations, or complete loss of sensation in the affected region. Objective assessment involved evaluating the patient\u0026rsquo;s response to pinprick stimuli with a blunt dental explorer, applied alternately to the contralateral, unaffected side. Tactile discrimination was assessed by determining whether the patient could accurately differentiate between the two stimuli, thereby monitoring the presence/absence and progression/regression of any neurosensory deficits.\u003c/p\u003e \u003cp\u003eThe surgical site was evaluated for gingival healing using Landry\u0026rsquo;s Healing Index. Signs of infection and wound dehiscence were recorded on the 1st, 3rd, and 7th postoperative days. In addition to clinical examination of surgical site, recurrence of the lesion and occurrence of any pathological fracture were assessed radiographically too at 6 months, 1 year and 3 years.\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eSample size was calculated using the following formula, keeping the power of the test at 80% and the level of significance at 5%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767969581.png\" style=\"width: 315px;\"\u003e\u003c/p\u003e \u003cp\u003eStatistical analysis was carried out using SPSS (Statistical Package for Social Sciences) 20.0, IBM, India software.\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was used for continuous variables, while numbers and percentages were used for categorical variables. The Wilcoxon signed rank test was used to analyse the reduction in the mean lesion size, mean bone formation and mean volume of lesion. Paired t-test was used to analyse mean lesion density, and Cochran\u0026rsquo;s Q-test was used to analyse neurosensory alterations. \u003cem\u003eP-\u003c/em\u003evalue\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 41eligible patients were screened initially. Of these, 5 patients were excluded due to presence of lesion with a rare likelihood of recurrence, specifically dentigerous cyst, nasopalatine duct cyst and radicular cyst. An additional 3 patients were excluded as they lost follow-up during study period. The final study sample consisted of 33 subjects (22 males, 11 females), aged between 20\u0026ndash;50 years, with a mean age of 32.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years. The mean age of males was 32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26 years, and that of females was 31.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.36 years. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic Variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (33.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (66.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDistribution of Lesion in jaw, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMandible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (72.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParasymphysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (27.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDistribution as per Histopathological diagnosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOKC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (39.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmeloblastoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (21.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCemento ossifying fibroma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOdontogenic myxoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eOKC, orthokeretinized odontogenic keretocyst;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eAOT, adenomatoid odontogenic tumour\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen reduction in the mean lesion size was calculated, the mean preoperative dimensions in SI, AP, and BL planes were 37.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22 mm, 29.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27 mm, and 17.94\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33 mm, respectively, which reduced postoperatively at 12 months to 6.94\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84 mm, 4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58 mm, and 3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98 mm. A statistically significant reduction in the mean lesion size was observed postoperatively using the Wilcoxon signed rank test. (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChange in the size of lesion over 12 months interval, in millimetres.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension Direction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandible (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaxilla\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOverall (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003e value* \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.47\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e33. 51\u0026thinsp;\u0026plusmn;\u0026thinsp;9.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e37.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.65\u0026thinsp;\u0026plusmn;\u0026thinsp;14.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.94\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.48\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e30.47\u0026thinsp;\u0026plusmn;\u0026thinsp;10.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e29.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.21\u0026thinsp;\u0026plusmn;\u0026thinsp;17.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e17.94\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSI, superoinferior; AP, anteroposterior; BL, buccolingual; SD; standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05, considered statistically significant\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eWilcoxon Signed Rank Test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCorrespondingly, the mean bone formation was 28.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.68 mm (78.6%) in SI, 22.54\u0026thinsp;\u0026plusmn;\u0026thinsp;9.66 mm (81.64%) in AP, and 12.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.53 mm (74.56%) in BL, with the greatest regeneration observed in the anteroposterior plane at 12 months. A statistically significant reduction in size was noted using Wilcoxon signed rank test. (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe mean volume of lesion showed a reduction of 83.15% in the maxilla and 94.05% in the mandible, with an overall reduction of 91.83% in all lesions from the pre- to post-operative at 12 months evaluation, representing a statistically significant reduction using the Wilcoxon signed rank test. (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChange in the volume of lesion, in millilitres and density, in Hounsfield units over 12 months.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMandible (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaxilla (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOverall (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVolume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.52 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.46 (2.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.50 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.24 (0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.36 (0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVolume reduction (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.05 (8.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.15 (8.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e91.83 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBone Density (HU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e480.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e189.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHU; Hounsfield unit\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05, considered statistically significant\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003eWilcoxon Signed Rank Test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003eb\u003c/sup\u003e Paired t-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, the mean lesion density increased significantly from 189.80 Hounsfield Units (HU) preoperatively to 480.50 HU at 12 months postoperatively using Paired t-test (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNeurosensory alterations, comprising of subjective (numbness and altered sensation) and objective changes (pin-prick test), were observed in 20 patients (60.6%) immediate postoperatively which persisted up to 3 months. The incidence decreased to 2 patients (6.1%) at 6 months, with only one patient (3%) exhibiting residual deficits at the 12-month follow-up. Tingling sensation was reported in 18 patients (54.54%) at 3 months follow-up, reduced to 2 patients (6.1%) at 6-month follow-up, and resolved completely by the 1-year follow-up, showing a statistically significant improvement using Cochran\u0026rsquo;s Q-test (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNeurosensory deficit assessment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParaesthesia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePost-op\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3rd Month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6th Month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e -value\u003csup\u003e* a\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumbness \u0026amp; absence\u003c/p\u003e \u003cp\u003eof Sensation-Present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAltered Sensation-Present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTingling-Present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePin Prick Test-Present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05, considered statistically significant\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e Cochran\u0026rsquo;s Q-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen wound healing was assessed, it showed marked hyperaemia without ulceration within first 72 hours. All patients exhibited uneventful wound healing with complete wound epithelialization by 2 weeks postoperatively. None of the patients showed signs of postoperative wound infection. However, wound dehiscence with underlying bone exposure was observed in 2 (6.06%) patients on 7th postoperative day, which later healed by secondary intention within 2 weeks. One patient (3.03%) developed a pathological jaw fracture at the 3-month follow-up. None of the lesions showed any clinical or radiographic evidence of recurrence during the entire follow-up period. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathologic fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eDescriptive analyses\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eManagement of benign odontogenic lesion of jaws depends on patient\u0026rsquo;s age, size, location and type of lesion, soft tissue involvement, previous treatments, histological variant and becomes further challenging owing to higher recurrence potential and local bone destruction. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSurgical management typically primarily involves enucleation, excision or curettage, but it is often insufficient to eliminate epithelial remnants or satellite cysts, which are responsible for its recurrence. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Hence, lesions with higher recurrence potential often require a more aggressive yet conservative approach, combining the above management strategies with adjuvant therapies like electro-, chemical, or thermal cauterization or mechanical techniques like peripheral ostectomy for their management.\u003c/p\u003e \u003cp\u003eChemical cauterization with Carnoy\u0026rsquo;s solution is considered the gold standard, primarily due to its ability to fixate and destroy residual cystic epithelium. However, a major limitation arose when chloroform - one of its key constituents was banned by the U.S. FDA in 1992. Its exclusion thereby reduced the solution\u0026rsquo;s efficacy and prompted the search for an ideal alternative adjuvant. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eCryosurgery, using liquid nitrogen serving as a cauterizing agent, was first described by Ralph C. Marcove in 1968 for the treatment of primary and metastatic bone tumors. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Living tissues freeze at approximately \u0026minus;\u0026thinsp;2.2\u0026deg;C, and temperatures below \u0026minus;\u0026thinsp;20\u0026deg;C are considered lethal to cells. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Liquid nitrogen achieves temperatures as low as \u0026minus;\u0026thinsp;196\u0026deg;C, inducing cell death through intracellular and extracellular ice crystal formation, osmotic and electrolyte imbalance, while preserving the inorganic bone matrix [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Its depth of penetration into bone (0.51\u0026ndash;1.52 mm) is comparable to Carnoy\u0026rsquo;s solution (\u0026asymp;\u0026thinsp;1.54 mm). [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMost protocols advocate rapid freezing to promote intracellular ice crystal formation, followed by slow thawing to induce electrolyte imbalance, thereby maximizing cytotoxicity. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] However, excessive freezing of bone during cryotherapy can impair the osteogenic response, especially when adjacent soft tissues are severely damaged. In such cases, bone resorption surpasses osteogenesis and weakens the bone, leading to an increased risk of pathological fractures. Therefore, maintaining an optimal temperature range is critical to prevent adverse effects. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Additional limitations of conventional liquid nitrogen cryotherapy include difficulties in handling large apparatus containing the agent within the bony cavity and ensuring its sterility. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGCC has emerged as an alternative to liquid nitrogen, achieving temperatures around \u0026minus;\u0026thinsp;50\u0026deg;C sufficient for cell lysis but not as extreme as \u0026minus;\u0026thinsp;196\u0026deg;C achieved through conventional cryotherapy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This controlled temperature provides effective cytotoxicity while minimizing structural bone damage and reduces the risk of pathological fracture. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] An additional advantage of GCC is its ease of delivery via calibrated spray through fine nozzle, allowing easier handling, precise application, better control and reduced risk of injury to adjacent soft tissues. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] GCC destroys tissue by rapid freezing and slow thawing, causing membrane disruption, protein denaturation and microvascular damage leading to ischemic necrosis. (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) Subsequent inflammatory response clears necrotic debris and healing occurs by secondary intention. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA GCC protocol similar to that used by Anjali et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] for their 10 cases of OKC was adopted in the present study, wherein enucleation/excision followed by peripheral ostectomy and 3 cycles of 1-minute GCC application with an intervening 1-minute thawing period after each cycle were carried out. However, it differs from the protocol used by Carneiro et al. and Cruz et al., who performed marsupialization followed by enucleation and a single 1-minute GCC application in 10 cases of ameloblastoma and 10 cases of keratocystic odontogenic tumour respectively. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDuring first 72 hours postoperatively, tissues surrounding the surgical area demonstrated pronounced hyperemia without evidence of ulceration, indicative of normal inflammatory response. Present study demonstrated uneventful wound healing proceeding in all patients with complete epithelialization and tissue repair by the end of approximately 2 weeks. However, postoperative wound dehiscence was observed in 2 patients (lesions size\u0026thinsp;\u0026gt;\u0026thinsp;4 cm) within the first week characterized by partial exposure of the underlying bony cavity, suggestive of lesion size being a probable contributory factor. Dehiscence was successfully managed through copious wound irrigation using 0.2% chlorhexidine, physiological saline solution, topical antibiotic application, and strict oral hygiene maintenance. Neither of the cases required extended systemic antibiotic therapy as there were no clinical signs of infection. In contrast, Carneiro et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and Cruz et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] observed wound dehiscence in all of their patients. The lower incidence of wound dehiscence in the present study can be attributed to meticulous wound protection with petroleum jelly-soaked gauze and strict adherence to the standardized GCC and asepsis protocol.\u003c/p\u003e \u003cp\u003eIn one case of parakeretinized odontogenic keretocyst, a pathological fracture was noted at 3 months postoperatively at mandibular body region which was successfully managed with open reduction and internal fixation. This was corresponding to an area with a critically thin residual bone of approximately 1.6 mm at the lower border. Although rare, this emphasizes the need to assess residual bone height preoperatively to mitigate fracture risk. Carneiro et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and Cruz et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] observed no pathological fractures which might be due to differences in lesion size, anatomical involvement, and selected treatment protocol.\u003c/p\u003e \u003cp\u003eImportantly, no recurrence was detected during the entire follow-up period of 3 years with a mean follow-up period of 18.3 months. While this supports the efficacy of GCC as an adjuvant in preventing recurrences of odontogenic lesions, a longer follow-up period is still being advocated. Carneiro et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], Cruz et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and Anjali et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] also observed no cases of recurrence in their study during a mean follow-up period of 70.55 months, 64.3 months, and 15 months, respectively.\u003c/p\u003e \u003cp\u003eOverall, GCC offered several advantages over conventional adjuvants such as ease of handling, adequate penetration depth, and reduced risk of collateral damage to adjacent bone, soft tissues and neural as well as vascular structures. The encouraging clinical, radiographic, and neurosensory outcomes in our study reinforce GCC as a biocompatible, safe and effective adjunct in the management of benign odontogenic jaw lesions.\u003c/p\u003e \u003cp\u003eRelatively small sample size, limited follow-up period, and fewer varieties of benign odontogenic lesions having higher recurrence potential are certain limitations of our study. Since recurrence of odontogenic lesions may manifest several years after treatment, long-term prospective studies with larger cohorts are required to validate the durability of these outcomes. Furthermore, comparative trials evaluating GCC directly against other adjuvant modalities such as modified Carnoy\u0026rsquo;s solution or liquid nitrogen would provide stronger evidence regarding its relative efficacy and safety. Future research should also focus on optimizing cryotherapy protocols, assessing long-term functional outcomes, and exploring adjunctive regenerative techniques to enhance bone healing in large residual defects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or the other support were received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeclared none.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Prior ethical approval was obtained from the Institutional Ethics Committee (AMC/IEC/OS/PG75/23) of AMC Dental College and Hospital, Ahmedabad, India.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirms that all human research participants provided informed consent for publication of the images in the figure 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShyam Chauhan and Shital Patel contributed equally towards conceptualization, designing, implementation and manuscript drafting. Zenish Bhatti contributed to data organization, interpretation and reviewing the manuscript for its intellectual content. Yasashvi Chavda, Neha Parmar and Shivam Kukadiya contributed in data collection and organization for the study. All authors have reviewed the manuscript before submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGohel A, Villa A, Sakai O (2016) Benign jaw lesions. Dent Clin 60(1):125\u0026ndash;141\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVallejo-Rosero KA, Camolesi GV, de S\u0026aacute; PL, Bernaola-Paredes WE (2020) Conservative management of odontogenic keratocyst with long-term 5 year follow-up: Case report and literature review. Int J Surg Case Rep 66:8\u0026ndash;15\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePogrel MA (1993) The use of liquid nitrogen cryotherapy in the management of locally aggressive bone lesions. J Oral Maxillofac Surg 51(3):269\u0026ndash;273\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLal B, Kumar RD, Alagarsamy R, Sundaram DS, Bhutia O, Roychoudhury A (2021) Role of Carnoy's solution as treatment adjunct in jaw lesions other than odontogenic keratocyst: a systematic review. Br J Oral Maxillofac Surg 59(7):729\u0026ndash;741\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiran DN, Bali A, Anupama A, Electro-Cauterization A (2014) Good Adjunctive Therapy To Treat Kcot's. Indian J Dent Sci. ;6(4)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarneiro JT, Couto AP, Carreira AS (2012) Use of gas combination cryosurgery for treating ameloblastomas of the jaw. J Cranio Maxillofacial Surg 40(8):e342\u0026ndash;e345\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePechalova P, Pavlov N (2012) A method for calculation of bone socket volume in radicular cysts of jaws by an orthopantomogram. Curierul Med 325(1):22\u0026ndash;23\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdullah WA (2011) Surgical treatment of keratocystic odontogenic tumour: A review article. Saudi Dent J 23(2):61\u0026ndash;65\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeiselman F (1994) Surgical management of the odontogenic keratocyst: conservative approach. J Oral Maxillofac Surg 52(9):960\u0026ndash;963\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcove RC, Miller TR (1969) Treatment of primary and metastatic bone tumors by cryosurgery. JAMA 207(10):1890\u0026ndash;1894\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosen G, Vered IY (1979) Cryosurgery for basal cell carcinoma of the head and neck. South Afr Med J 56(1):26\u0026ndash;27\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhittaker DK (1984) Mechanisms of tissue destruction following cryosurgery. Ann R Coll Surg Engl 66(5):313\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradley PF, Fisher AD (1975) The cryosurgery of bone. An experimental and clinical assessment. Br J Oral Surg 13(2):111\u0026ndash;127\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNair AP, Shyamsunder M, Subash P, Sankar G (2022 Sep) Efficacy of gas combination cryotherapy in the management of odontogenic keratocyst of the maxilla and mandible: a pilot study. J Oral Maxillofac Surg 1:1\u0026ndash;1\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Souza Cruz EL, da Silva Tabosa AK, Falc\u0026atilde;o AS, Tartari T, de Menezes LM, da Costa ET, J\u0026uacute;nior JT (2017) Use of refrigerant spray of a propane/butane/isobutane gas mixture in the management of keratocystic odontogenic tumors: a preliminary study. Oral maxillofacial Surg 21:21\u0026ndash;26\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKujan O, Azzeghaiby SN, Tarakji B, Abuderman A, Sakka S (2013) Cryosurgery of the oral and peri-oral region: a literature review of the mechanism, tissue response, and clinical applications. J Invest Clin Dent 4(2):71\u0026ndash;77\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarneiro JT, Falc\u0026atilde;o AS, da Silva Tabosa AK, Shinohara EH, de Menezes LM (2014) Management of locally aggressive mandibular tumours using a gas combination cryosurgery. J Cranio-Maxillofacial Surg 42(5):423\u0026ndash;427\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"odontogenic cyst, odontogenic tumour, cryotherapy, adjuvant therapy, bone regeneration","lastPublishedDoi":"10.21203/rs.3.rs-8448215/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8448215/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eBenign odontogenic lesions, including odontogenic keratocyst, ameloblastoma, and adenomatoid odontogenic tumor, are locally aggressive jaw lesions with a high risk of recurrence. Their management ranges from conservative procedures to radical resections, but countering recurrence still remains a challenge. Various adjuvants such as chemical cauterizing agents like Carnoy\u0026rsquo;s solution and thermal methods including cryotherapy have been utilized to reduce recurrence rate. Hence, present study was aimed to evaluate the management outcome for benign odontogenic lesions having high recurrence rate following usage of gas combination cryotherapy as an adjunct.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThirty-three patients aged 20\u0026ndash;50 years having benign odontogenic lesions with high recurrence rate were included. Patients with lesion recurrence following previous surgery were excluded. Lesion dimensions, bone density and volume were measured pre- and postoperatively using cone-beam computed tomography. Incidence of neurosensory disturbances, pathological fracture and recurrence too were noted. Wilcoxon signed-rank test was used to evaluate lesion size and volume, paired t-test for bone density, and Cochran\u0026rsquo;s Q-test for neurosensory outcomes, with significance set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eResults showed a significant 91.83% overall reduction in lesion volume, with maxillary and mandibular lesions reducing by 83.15% and 94.05%, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Bone density improved significantly from 189.80 to 480.50 Hounsfield Units, indicating considerable bone regeneration (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The treatment was well tolerated with minimal complications and no recurrence observed during entire follow-up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings suggest GCC is a safe and effective adjunctive treatment to enhance bone healing and reduce recurrence rates in aggressive benign odontogenic lesions of the jaw.\u003c/p\u003e","manuscriptTitle":"Gas Combination Cryotherapy as an Adjuvant in the Management of Benign Odontogenic Jaw Lesions: A Prospective Clinical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 06:19:19","doi":"10.21203/rs.3.rs-8448215/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0e8eacbe-a545-4c80-a75c-b493006b0943","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T11:36:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 06:19:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8448215","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8448215","identity":"rs-8448215","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}