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BDS4 Oral Surgery > 10 - Soft tissue lesions and biopsy techniques > Flashcards

10 - Soft tissue lesions and biopsy techniques Flashcards

1
Q

What is the function of biopsy?

A
  • sample tissue for histopathological analysis
  • confirm or establish diagnosis
  • determine prognosis
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2
Q

What considerations should be taken before biopsy?

A
  • should I biopsy? or refer
  • why am I biopsying?
  • what do I need to ask the pathologist?
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3
Q

What are the different tissue sampling techniques?

A
  • aspiration
  • surgical
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4
Q

What are the types of aspiration biopsy?

A
  • blood sample
  • aspiration from lesion
  • fine needle aspiration
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5
Q

Describe a blood sample.

A
  • type of biopsy as blood is tissue
  • venous blood typically used
  • FBC, U and Es, haematinics etc
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6
Q

Describe an aspiration from a lesion.

A
  • aspiration from an abscess prevents contamination from oral fluids
  • protects anaerobic species
  • aspiration determines if lesion is solid or fluid filled
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7
Q

Describe a fine needle aspiration.

A
  • aspiration of cells from solid lesion
  • useful in neck swellings, salivary gland lesions
  • sent to cytology
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8
Q

What are the types of surgical biopsy?

A
  • excisional
  • incisional
  • punch
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9
Q

Describe an excisional biopsy.

A
  • removal of all clinically abnormal tissue
  • should be confident of provisional diagnosis
  • typically benign lesions
  • discrete lesions
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10
Q

Describe an incisional biopsy.

A
  • representative tissue sample of larger lesions
  • when uncertain of diagnosis
  • typically leukoplakia, lichen planus, SCC
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11
Q

Why is an incisional biopsy preferred for a suspected SCC?

A

Leave evidence of lesion for surgeons who require a clear margin

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12
Q

Describe a punch biopsy.

A
  • type of incisional biopsy
  • removes core of tissue with minimal damage
    +/- sutures to close
  • hollow trephine 4/6/8mm diameter
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13
Q

How should you select an area to biopsy?

A
  • large enough
  • representative
  • may require more than one biopsy
  • include perilesional tissue when biopsying ulcers
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14
Q

When should you refer to a specialist to complete a biopsy?

A
  • suspicious lesions
  • lumps within upper lip
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15
Q

Why are lumps within the upper lip of concern?

A
  • always assume cancerous until proven otherwise
  • small salivary neoplasm are very common in this site
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16
Q

How should you sent a sample to pathology?

A
  • in 10% formalin
  • suture can aid orientation
  • relevant clinical information should be included in referral
  • can be placed on filter paper, but gauze distorts
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17
Q

What areas should you avoid biopsying?

A
  • salivary gland orifices
  • tip of tongue
  • areas close to nerves and large blood vessels
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18
Q

Define pedunctulated.

A

Attached with stalk like projection

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19
Q

What is a fibrous epulis?

A
  • swelling arising from gingivae
  • hyperplastic response to irritation (eg plaque, calculus, restoration)
  • smooth surface, rounded swelling, pink, pendunculated
20
Q

How do you manage a fibrous epulis?

A
  • excisional biopsy
  • coe pack dressing
  • removal of source of irritation
21
Q

What is a coe pack dressing?

A

Eugenol free periodontal dressing

22
Q

What is a fibroepithelial polyp?

A
  • fibrous overgrowth caused by frictional irritation or trauma
  • semi pedunctulated or sessile
  • pink, smooth surface
  • most commonly found on buccal mucosa and inner surface of lip
  • low cancer transformation
23
Q

Define sessile.

A

Fixed in place

24
Q

How do you manage a fibroepithelial polyp?

A
  • surgical excision
  • no need for deep excision or wide margin
25
Q

What is a giant cell epulis?

A
  • peripheral giant cell granuloma
  • common in teenagers in the anterior regions of mouth
  • deep red/purple, wide base
26
Q

What is the management of a giant cell epulis?

A
  • xray to ensure not centrally originating (appears radiolucent, +ve requires blood test)
  • surgical excision with curettage of base
  • coe pack dressing
27
Q

What is a haemangioma?

A
  • developmental overgrowth
  • exophytic (appears like bunch of grapes)
  • blue in colour, pressure will blanche
28
Q

Define exophytic.

A

Tending to grow outward beyond the surface epithelium from which it originates

29
Q

What is the management of a haemangioma?

A
  • surgical removal
  • cryotherapy (doesn’t allows for histological diagnosis, although not required as behavioural is classical)
30
Q

What is a lipoma?

A
  • benign neoplasm of fat
  • soft pale yellow swelling
  • sessile
31
Q

What is the management of a lipoma?

A

Excision

32
Q

What is pregnancy epulis?

A
  • histologically the same as a pyogenic granuloma
  • often bleed easily, related to calculus
  • hormonal changes enhance response to tissue irritation
33
Q

What is the management of pregnancy epulis?

A
  • small lesions do not require excision and usually regress after birth
  • larger lesions should be excised
34
Q

What is a pyogenic granuloma?

A
  • overgrowth of granulation tissue that arises from failure of normal healing
  • can be related to extraction sockets or traumatic soft tissue injuries
  • red in colour
35
Q

What is the management of a pyogenic granuloma?

A
  • surgical excision
  • curettage of base
36
Q

What is a squamous cell papilloma?

A
  • benign neoplasm
  • most commonly found on palate, buccal mucosa or lips
  • pedunculated
  • white surface with cauliflower appearance
37
Q

What is the management of a squamous cell papilloma?

A
  • excision at base
  • test for HPV
38
Q

What is denture hyperplasia?

A
  • hyperplastic reaction to poorly fitting denture
  • roll of excess tissue on outer aspect of denture flange or between flange and ridge
  • most common in lower labial sulcus
39
Q

What is the management of denture hyperplasia?

A
  • trim flange of denture (new denture required long term)
  • remove excess tissue
  • is large area removed, coe pack dressing
40
Q

What is a leaf fibroma?

A
  • chronic irritation caused by denture
  • would be round, but covered by denture so is flattened
  • pedunculated
41
Q

What is the management of a leaf fibroma?

A

Excision

42
Q

What is a mucocele?

A
  • mucus extravasation cyst
  • damage to minor salivary gland causes saliva to leak into submucosal layer
  • soft bluish swelling, fluid filled
  • recurrent
43
Q

In what orientation should the excision of a mucocele be?

A
  • vertical
  • horizontal incision can cause nerve damage and numbness
44
Q

Why is removing a ranula risky?

A

Surrounding structures including nerves and major blood vessels can be damaged

45
Q

What is a squamous cell carcinoma?

A
  • may present as a lump, red or white patch, or as a non-healing ulcer
  • classically described as ulcer, rolled margin and indurated
  • lesion may bleed easily and is fixed in placed
46
Q

Define induration.

A

Hard

47
Q

What are the steps when you discover a suspected SCC?

A
  • urgent referral via rapid access pathway
  • referral by phone then ski gateway

BDS4 Oral Surgery (22 decks)

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