L13 - Biopsy of hard and soft tissue Flashcards
outline excisional biopsy
border
elliptical incision with length of the incision around 3x
undermining tissue layers for tension free closure
wedge biopsy (basically an elliptical biopsy with 3rd dimension of depth)
local anatomy consideration in planning biopsy
marking margins of specimen
if incisional biopsy
elliptical incision technique
location of biopsy crucial to obtain diagnostic information
in general of ulcer
biopsy
- incisional
biopsy periphery of ulcer at the margin of normal and abnormal tissue
in general of solid tumor mass
biopsy
incisional biopsy
- biopsy CENTER of solid tumor mass staying away from margin of lesion
basic instrumentation
scissors - used for sharp and blunt dissection
tissue holding forceps
claps-hemostats
electrocautery
when to perform a soft tissue biopsy
1-5
- ulceration that fails to heal despite removal of irritant
- extraction socket that does not heal despite more then adequate time
- tissue that fails to respond to adequate routine dental hygeine measures
- persistent red / white disease
- unexplained pigmented lesions which do not blanch on pressure
3 examples of specialized common soft tissues biopsies
- marsupialization for ranula
- lips- lining up cutaneous-vermilion border
- vesicullo-bullous lesion
vesicullo- bullous lesion
- periphery of ulcer
- consider uninvolved or attached gingival sites to biopsy
- special storage media for specimen
what not to biopsy
- geographic tongue
- fordyce granules
- the occasional apthous ulcer
- median rhomboid glossitis
- recurrent intra-oral herpetic lesions
when to consider biopsy of boney lesions
- parasthesia
- unusual unexplained root resorption
- unexplained tooth displacement
- atypical / asymmetric marrow pattern
block resection for radiolucent
for large aggressive lesions
marginal resection for radiolucent
consider with multilocular or more aggressive odontogenic lesions
pathology diagnosis starts with ..?
patient history and a good exam
what type removes the whole thing
excisional biopsy
surorund with normal border of tissue
biopsy what with ulcer
the peripheray of it not the center
incisional biopsy - general
taking a little bit
relatively narrow and relatively deep
desirable shape for incisional biopsy
deep and narrow
NOT broad and shallow
basic biopsy intrusments
hemostat and currette
diagram of excisional biopsy
elliptical for closure
below submucosal layer
suture closed primarily
circular incsision?
NO – cant close
length and width of excisional biopsy
roughly 3x longer than it is wide
fluid filled lesion - history of trauma
been there for awhule
mucocele
elliptical incision
going beyond where lesion is
separate from underlying muscle layer
remove additional minor salivary gland tissue?
yes – because mucocele has potential to come back
achieving hemostasis
do this before you suture closed
how to get tension free closure
undermine mucosal edges
- so undermine the tissue before suture
if dont - sutures can pull open
descrete non -indurated lesion on dorsal tongue
excisional or incisional?
excisional biopsy - likely a viral lesion on the tongue like a papilloma
what do you have to do before make incision on the tongue?
traction suture - controls the position of the tongue
- to be able to keep the tongue open
lesion on outside of tongue - what type of suture
inverted vicryl sutures
picture for incisional vs excisional
firm mass on buccal vestibule
well circumscribed
maybe fibroma?
neurofibroma?
structure near by?
- mental nerve parasthesia – bicuspid area
large exophytic ulcer on lateral ventral aspect of the tongue
papible cervical lymph node
soreness is present
incision where?
fungal / cancer?
biopsy
- AT THE MARGIN OF IT
NOT THE CENTER - filled with acute and chronic inflammatory cells – not good biopsy
former ‘smokers patch’ can become
invasive squamous cell carcinoma
biopsy smokeless tobacco patch
yes
unexplained pigmented lesions
unexplained area – biopsy
non-healing extraction sockets
yes – needs to be biopsied
after 8 weeks
- needs to be excised
tissue that does not respond to therapy
biopsy
prevent late gingival carcinoma
red/ whire lesion with non healing ulcer
lichen planus
erosive lichen planus - low risk of malignancy but still have to biopsy
fibro-vascular lesion? implication
needs to be biopsied - likely to bleed
usually requires electro-cautery
- if dont have these might rethink
pregnant ? what to do first?
get lab tests first
large mass hard / soft palate
firm dome shaped
excisional biopsy
- borders extend beyond the mass
- subperiosteal disection - to the hard palate
- obturator made
ranula marsupialization technique
scissors to create a incisiaonl spread
- take out whole thing
- take care of bleeding
- undermining tissue – no tension
- suture
firm mass biopsy where / no ulceration where incisional
CENTER
-
mucosal stripping? ventral lateral tongue
non-indurated (soft)
excisional
- removed it all
- using the traction control suture because on tongue
wedge resection technique
3-D
- lips most of the time
- orient the vermillion border
- deeper
vesiculobullous lesion
+ nikolsky sign
sloughing of tissue
like pemphigus
may take biopsy in two sites - not in the center
- may use some normal tissue too
topical steroids and anti-fungal agents
non-healing ulcer at least - pain
vs painless ulcer
6 weeks non healing – be worried about this - but may not be cancer - but needs to be biopsied
painless - insitu cancer
trauma and ulcer
remove the trauma - allow to heal – if does not heal - then decide to biopsy
lesions we do not biopsy - he noted on the palate
small little red dots – because we have history of multiple palatal injections
shallow ulcer with erythematous base?
ask them what?
eat something hot?? – burn
dont need to biopsy
acute candidiasis?
dont need to biopsy
large uleration on tongue - lateral
could be viral
primary syphalis
molt currette
for bony lesions
general rule for curette use
used on lesions which are well defined on x-ray
incisions for bony lesions where - in general
must lie over solid bone
limit chance of complications like communication with sinus and nasal cavity
cyst in the maxilla? displace to
can displace into sinus and nasal cavity
what to do with all large cystic radiolucencies?
ASPIRATE - rule out a central vascular lesion
why?
- wont be able to stop the bleeding
removal technique for bigger lesions like an ameloblastoma
do an incisional biopsy first to know what dealing with
block incision
- normal bone periphery included in specimen
about 1.5 cm away from lesion - like this normal has to come out with it
fiibro-osseous lesions use
punch biopsy
unexplained root resorption?
biopsy the peri-apical tissue when do extraction
general principles of radio-opaque fibro-osseouos lesions?
- biopsy central of lesion
- punch biopsy technique
- minimal periosteal elevation - bone shave / recontouring for very large lesions of fibrous dysplasia
