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Oral Pathology > Healing of Oral Wounds > Flashcards

Healing of Oral Wounds Flashcards

1
Q

Wound Healing

Early vascular response to injury

A
  • Starts as inflammation through the following…
  • Initial transient vasoconstriction followed by vasodilation.
  • Vasodilation is caused by action of histamine, prostaglandins, and other vasodilatory substances.
  • Dilation causes intercellular gaps to occur, which allows egress of plasma and emigration of leukocytes.
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2
Q

Wound Healing

Inflammatory stage of wound repair

A
  • Wound fills with clotted blood, inflammatory cells and plasma.
  • Adjacent epithelium begins to migrate into wound along edge of the wound.
  • Undifferentiated mesenchymal cells begin to transform into fibroblasts.
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3
Q

Wound Healing

Migratory phase of fibroblastic stage of wound repair

A
  • Continued epithelial migration under the fibrinous exudate.
  • Leukocytes dispose of foreign and necrotic material.
  • Capillary ingrowth begins.
  • Fibroblasts migrate into wound along fibrin strands.
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4
Q

Wound Healing

Proliferative phase of fibroblastic stage of wound repair

A
  • Proliferation increases epithelial thickness.
  • Collagen fibers are haphazardly laid down by fibroblasts.
  • Budding capillaries begin to establish contact with their counterparts from other sites in the wound.
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5
Q

Wound Healing

Remodeling stage of wound repair

A
  • Epithelial stratification is restored.
  • Fibrinous exudate resorbs, often leaving a depressed scar.
  • Collagen is remodeled into more efficiently organized patterns.
  • Fibroblasts slowly reduce and vascular integrity is re-established.
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6
Q

Wound Healing

Wound contraction

A
  • Begins near the end of fibroplasia and continues during the early portion of remodeling.
  • Wound contraction diminishes the size of the wound.
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7
Q

Indications for biopsy

A
  • Any persistent pathologic condition which cannot be diagnosed clinically
  • Any lesion thought to be malignant/premalignant
  • To confirm clinical diagnosis
  • Any condition not responding to routine management
  • To allay cancer fears
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8
Q

Biopsy Types

A

- Excisional -

remove entire lesion (benign tumor)

- Incisional -

only take a small piece of lesion (only diagnostic)

- Punch -

- Needle -

ex. Fine Needle Aspiration (FNA)

- Aspiration -

Place Biopsy Specimen in 10% neutral, buffered formalin

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9
Q

Incisional biopsy

A
  • If the lesion is larger than 1cm or in a hazardous location or whenever there is a great suspicion of malignancy.
  • Is used to establish diagnosis.
  • It is a diagnostic biopsy.
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10
Q

Excisional biopsy

A
  • Is used to remove the lesion.
  • It is a diagnostic and therapeutic biopsy.
  • For lesions that are small and you are confident are benign
  • Do not excise a lesion suspected of being malignant
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11
Q

Primary healing

A
  • Healing by primary intention.
  • When the margins can be approximated.
  • Usually heals with minimal scar.
  • Most Ideal
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12
Q

Secondary healing

A
  • Healing by secondary intention.
  • An open wound “granulates in”.
  • Heals with scarring.
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13
Q

Cytology/Exfolative Cytology

A

the removal of individual cells, usually in order to determine microscopically if they appear normal or abnormal. It usually does not provide a definitive diagnosis.

  • screening for cancer usually
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14
Q

Cytology Advantages and Disadvantages

A

Cytology Advantages

*Safe

*Bloodless

*Painless

*Quick

*Screening

Cytology Disadvantages

*Only for surface lesions affecting epithelium

*Cannot establish a definitive diagnosis

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15
Q

Cytology Grades

A

Grade I Normal (No biopsy)

Grade II Atypical (Biopsy)

Grade III Borderline (Biopsy)

Grade IV Suggestive (Biopsy)

Grade V Positive (Biopsy)

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16
Q

What is indicated for cytology?

A

*Premalignant/malignant lesions

*HSV

  • Cytopathic viral effect
  • “Multinucleation”

*Candidosis

17
Q

Oral CDX Brush “Biopsy”

A

NOT A BIOPSY - NOT A DEFINITIVE DIAGNOSIS

  1. Cytological evaluation for premalignant/malignant lesions
  2. Improved cell harvesting
    - All cell layers
  3. Improved computer-based screening of specimen
  4. Improved diagnostic accuracy
  5. Atypical and positive results must be biopsied
  6. Does not provide definitive diagnosis
18
Q

Immunofluorescence

A

Diagnostic technique to identify autoantibodies

  • Direct (DIF)
  • Autoantibodies in tissue
  • Indirect (IIF)
  • Circulating autoantibodies in blood

Immunofluorescent testing generally reserved for conditions that you suspect are autoimmune (pemphigus vulgaris, mucous membrane pemphigoid)

Most oral diseases are (+) on Direct but (-) on indirect IF.

DIF biopsies cannot be placed in traditional fixative, a transport media is required

19
Q

Healing of Extraction Wound

First Week

A
  • The blood clot begins to undergo organization by the ingrowth of fibroblasts and capillaries from the residual periodontal ligament and adjacent bone marrow.
20
Q

Healing of Extraction Wound

Second Week

A
  • The blood clot is becoming organized.
  • PDL begins degeneration and the socket wall appears frayed.
  • Epithelium proliferates over the wound surface.
21
Q

Healing of Extraction Wound

Third Week

A
  • The original clot is organized by granulation tissue.
  • Early bone (osteoid) is formed by osteoblasts arising in the PDL and adjacent bone.
  • The crest of the alveolar bone is rounded off by osteoclastic resorption.
  • Epithelium completely covers the surface
22
Q

Healing of Extraction Wound

Fourth Week

A
  • Continued deposition of bone.
  • Much of the early bone is poorly calcified and is not evident on radiographs.
  • Radiographic evidence of bone formation is seen after six or eight weeks.
  • Evidence of differences in new bone in the alveolar socket will persist for four to six months.
23
Q

Localized Acute Alveolar Osteomyelitis (Dry Socket)

A
  • Due to loss of the blood clot from extraction site.
  • The socket appears dry and the bone is exposed.
  • Produces a foul odor and severe pain but no suppuration.
24
Q

Fibrous Healing of an Extraction Wound

A
  • Results from a difficult surgical extraction accompanied by loss of lingual and labial or buccal plates of bone with accompanying loss of periosteum.

Radiographic - appears as a circumscribed radiolucent area at the site of previousextraction wound.

  • may be mistaken for a residual cyst or granuloma.
25
Q

Focal osteoporotic bone marrow defect

A

Radiolucency in bone from bone marrow expansion may not be pathologic

  • Aberrant healing – many are in extraction sockets
  • Hyperplasia due to chronic anemia
  • ↑ Females 75%
  • ↑↑ Md (posterior)

Asymptomatic, no expansion

Radiolucencies, often ill-defined but with faint internal trabeculation

26
Q

Localized Tissue Overgrowth

A
  • Often a fragment of bone will become lodged in the socket and induce tissue hyperplasia (pyogenic granuloma, peripheral giant cell granuloma, inflammatory fibrous hyperplasia - all covered later).
  • Tissue growing from an extraction site can also represent malignancy growing along the course of least resistance.

Oral Pathology (5 decks)

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