L16 Surgical management of common benign dentoalveolar lesions

Question 1

What features may a lesion present with?

Answer 1

• Presence of swelling
• Change in colour and texture
• Breakdown of overlying mucosa
• Asymmetry related to sub mucosal changes e.g. bone

Question 2

What should you include when describing a lesion?

Answer 2

• Site
• Size
• Shape
• Surface
• Structures
• Superficiality
• Colour
• Consistency

Question 3

What methods could be used to diagnose a lesion?

Answer 3

• Radiographs
• Diagnostic biopsy
• Lab investigations e.g. pathology, microbiology, haematology

Question 4

What does fluctuance mean?

Answer 4

A fluid filled lesion.
- Possibly contains pus, blood or cystic fluid
- Cyst contents tend to be clear
- Blood could indicate a haemangioma

Question 5

What is a culture and sensitivity test?

Answer 5

• Sample of lesion is cultured on agar plate and identified
• Sensitivity to different antibiotics is checked, appropriate abx prescribed

Question 6

Describe the various biopsy types.

Answer 6

• Excisional: complete removal of all abnormal tissue with surrounding normal tissue
• Incisional: removal of a portion of normal and abnormal tissue
• Punch: removing a core of abnormal tissue
• Aspiration: fine needle cytology for deep soft tissue lesions
• Exfoliative cytology: abrasive removal of superficial layers (scraping top layers)

Question 7

What type of LA is used during a biopsy?

Answer 7

• Regional block is ideal: numb the area around the lesion rather than the lesion itslef
• Avoids disruption of the anatomical architecture of the lesion
• If a block is impractical, do infiltration at a distance from the lesion
• Close the area with dissolvable sutures

Question 8

What information do you need to provide the pathologist with?

Answer 8

• Date of specimen
• Patient details, relevant MH, age, gender
• Clinical information, previous biopsy/treatment
• Site, size, shape, texture, colour, duration
• Investigations undertaken e.g. radiograph, haematology
• Specimen details, orientation and location
• Type of investigation required e.g. histology
• Date of next appointment
• Name and contact details of surgeon

Question 9

How is denture-induced hyperplasia treated?

Answer 9

• Common fibrotic lesion
• Modify denture, see if lesion becomes smaller
• Local anaesthesia, excise lesion
• May require skin graft (bottom right image) if the area is particularly large

Question 10

What is a cyst?

Answer 10

A pathological epithelial lined cavity filled with fluid.
Cysts in the oral region are most commonly tooth related (70%).

Question 11

How are cysts managed?

Answer 11

Must remove contents of cysts, encourage healing and stimulate remodelling.

2 options:
- Encucleation
- Marsupialisation

Question 12

Describe enucleation of cysts.

Answer 12

• Complete removal
• Expose area, remove cyst contents and lining, suture
• Cyst cavity will fill with a blood clot and over 3-6 months the area will fill with bone
• Carries risk of mandible fracture

Question 13

Describe marsupialisation of cysts.

Answer 13

• E.g. for patient who is medically compromised who cannot undergo general anaesthetic, or in cases where there is risk of jaw fracture
• Local anaesthetic
• Cyst lining left behind
• Not complete removal
• Cystic cavity heals itself from the base

Question 14

Name lesions with inflammatory components.

Answer 14

• Epiludes
• Giant cell lesions (may resist conventional excision, may need to curettage surrounding bone and extract adjacent teeth)

Question 15

Describe vascular lesions.

Answer 15

• Easier to diagnose due to purply red colour
• Will blanche when pressed
• Haemangiomas also known as hamartomas
• Varied presentation: discrete lobules, multiple lesions
• Do not excise
• Cryosurgery: cold probe (liquid carbon dioxide) placed on lesion to shrink it, will eventually completely regress