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Oral Surgery > L13 - Biopsy of hard and soft tissue > Flashcards

L13 - Biopsy of hard and soft tissue Flashcards

1
Q

outline excisional biopsy

A

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

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2
Q

if incisional biopsy

A

elliptical incision technique

location of biopsy crucial to obtain diagnostic information

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3
Q

in general of ulcer

biopsy

A
  • incisional

biopsy periphery of ulcer at the margin of normal and abnormal tissue

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4
Q

in general of solid tumor mass

biopsy

A

incisional biopsy

- biopsy CENTER of solid tumor mass staying away from margin of lesion

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5
Q

basic instrumentation

A

scissors - used for sharp and blunt dissection

tissue holding forceps

claps-hemostats

electrocautery

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6
Q

when to perform a soft tissue biopsy

1-5

A
  1. ulceration that fails to heal despite removal of irritant
  2. extraction socket that does not heal despite more then adequate time
  3. tissue that fails to respond to adequate routine dental hygeine measures
  4. persistent red / white disease
  5. unexplained pigmented lesions which do not blanch on pressure
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7
Q

3 examples of specialized common soft tissues biopsies

A
  1. marsupialization for ranula
  2. lips- lining up cutaneous-vermilion border
  3. vesicullo-bullous lesion
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8
Q

vesicullo- bullous lesion

A
  1. periphery of ulcer
  2. consider uninvolved or attached gingival sites to biopsy
  3. special storage media for specimen
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9
Q

what not to biopsy

A
  1. geographic tongue
  2. fordyce granules
  3. the occasional apthous ulcer
  4. median rhomboid glossitis
  5. recurrent intra-oral herpetic lesions
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10
Q

when to consider biopsy of boney lesions

A
  1. parasthesia
  2. unusual unexplained root resorption
  3. unexplained tooth displacement
  4. atypical / asymmetric marrow pattern
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11
Q

block resection for radiolucent

A

for large aggressive lesions

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12
Q

marginal resection for radiolucent

A

consider with multilocular or more aggressive odontogenic lesions

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13
Q

pathology diagnosis starts with ..?

A

patient history and a good exam

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14
Q

what type removes the whole thing

A

excisional biopsy

surorund with normal border of tissue

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15
Q

biopsy what with ulcer

A

the peripheray of it not the center

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16
Q

incisional biopsy - general

A

taking a little bit

relatively narrow and relatively deep

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17
Q

desirable shape for incisional biopsy

A

deep and narrow

NOT broad and shallow

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18
Q

basic biopsy intrusments

A

hemostat and currette

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19
Q

diagram of excisional biopsy

A

elliptical for closure

below submucosal layer

suture closed primarily

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20
Q

circular incsision?

A

NO – cant close

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21
Q

length and width of excisional biopsy

A

roughly 3x longer than it is wide

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22
Q

fluid filled lesion - history of trauma

been there for awhule

A

mucocele
elliptical incision
going beyond where lesion is

separate from underlying muscle layer

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23
Q

remove additional minor salivary gland tissue?

A

yes – because mucocele has potential to come back

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24
Q

achieving hemostasis

A

do this before you suture closed

25
Q

how to get tension free closure

A

undermine mucosal edges
- so undermine the tissue before suture

if dont - sutures can pull open

26
Q

descrete non -indurated lesion on dorsal tongue

excisional or incisional?

A

excisional biopsy - likely a viral lesion on the tongue like a papilloma

27
Q

what do you have to do before make incision on the tongue?

A

traction suture - controls the position of the tongue

- to be able to keep the tongue open

28
Q

lesion on outside of tongue - what type of suture

A

inverted vicryl sutures

29
Q

picture for incisional vs excisional

firm mass on buccal vestibule
well circumscribed

maybe fibroma?
neurofibroma?

A

structure near by?

- mental nerve parasthesia – bicuspid area

30
Q

large exophytic ulcer on lateral ventral aspect of the tongue

papible cervical lymph node

soreness is present

incision where?

A

fungal / cancer?
biopsy
- AT THE MARGIN OF IT

NOT THE CENTER - filled with acute and chronic inflammatory cells – not good biopsy

31
Q

former ‘smokers patch’ can become

A

invasive squamous cell carcinoma

32
Q

biopsy smokeless tobacco patch

A

yes

33
Q

unexplained pigmented lesions

A

unexplained area – biopsy

34
Q

non-healing extraction sockets

A

yes – needs to be biopsied

after 8 weeks
- needs to be excised

35
Q

tissue that does not respond to therapy

A

biopsy

prevent late gingival carcinoma

36
Q

red/ whire lesion with non healing ulcer

A

lichen planus

erosive lichen planus - low risk of malignancy but still have to biopsy

37
Q

fibro-vascular lesion? implication

A

needs to be biopsied - likely to bleed

usually requires electro-cautery
- if dont have these might rethink

38
Q

pregnant ? what to do first?

A

get lab tests first

39
Q

large mass hard / soft palate

firm dome shaped

A

excisional biopsy

  • borders extend beyond the mass
  • subperiosteal disection - to the hard palate
  • obturator made
40
Q

ranula marsupialization technique

A

scissors to create a incisiaonl spread

  • take out whole thing
  • take care of bleeding
  • undermining tissue – no tension
  • suture
41
Q

firm mass biopsy where / no ulceration where incisional

A

CENTER

-

42
Q

mucosal stripping? ventral lateral tongue

non-indurated (soft)

A

excisional

  • removed it all
  • using the traction control suture because on tongue
43
Q

wedge resection technique

A

3-D

  • lips most of the time
  • orient the vermillion border
  • deeper
44
Q

vesiculobullous lesion

A

+ 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

45
Q

non-healing ulcer at least - pain

vs painless ulcer

A

6 weeks non healing – be worried about this - but may not be cancer - but needs to be biopsied

painless - insitu cancer

46
Q

trauma and ulcer

A

remove the trauma - allow to heal – if does not heal - then decide to biopsy

47
Q

lesions we do not biopsy - he noted on the palate

A

small little red dots – because we have history of multiple palatal injections

48
Q

shallow ulcer with erythematous base?

ask them what?

A

eat something hot?? – burn

dont need to biopsy

49
Q

acute candidiasis?

A

dont need to biopsy

50
Q

large uleration on tongue - lateral

A

could be viral

primary syphalis

51
Q

molt currette

A

for bony lesions

52
Q

general rule for curette use

A

used on lesions which are well defined on x-ray

53
Q

incisions for bony lesions where - in general

A

must lie over solid bone

limit chance of complications like communication with sinus and nasal cavity

54
Q

cyst in the maxilla? displace to

A

can displace into sinus and nasal cavity

55
Q

what to do with all large cystic radiolucencies?

A

ASPIRATE - rule out a central vascular lesion

why?
- wont be able to stop the bleeding

56
Q

removal technique for bigger lesions like an ameloblastoma

A

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

57
Q

fiibro-osseous lesions use

A

punch biopsy

58
Q

unexplained root resorption?

A

biopsy the peri-apical tissue when do extraction

59
Q

general principles of radio-opaque fibro-osseouos lesions?

A
  1. biopsy central of lesion
    - punch biopsy technique
    - minimal periosteal elevation
  2. bone shave / recontouring for very large lesions of fibrous dysplasia

Oral Surgery (26 decks)

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