L16 Surgical management of common benign dentoalveolar lesions Flashcards

1
Q

What features may a lesion present with?

A
  • Presence of swelling
  • Change in colour and texture
  • Breakdown of overlying mucosa
  • Asymmetry related to sub mucosal changes e.g. bone
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2
Q

What should you include when describing a lesion?

A
  • Site
  • Size
  • Shape
  • Surface
  • Structures
  • Superficiality
  • Colour
  • Consistency
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3
Q

What methods could be used to diagnose a lesion?

A
  • Radiographs
  • Diagnostic biopsy
  • Lab investigations e.g. pathology, microbiology, haematology
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4
Q

What does fluctuance mean?

A

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

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5
Q

What is a culture and sensitivity test?

A
  • Sample of lesion is cultured on agar plate and identified
  • Sensitivity to different antibiotics is checked, appropriate abx prescribed
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6
Q

Describe the various biopsy types.

A
  • 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)
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7
Q

What type of LA is used during a biopsy?

A
  • 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
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8
Q

What information do you need to provide the pathologist with?

A
  • 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
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9
Q

How is denture-induced hyperplasia treated?

A
  • 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
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10
Q

What is a cyst?

A

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

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11
Q

How are cysts managed?

A

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

2 options:
- Encucleation
- Marsupialisation

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12
Q

Describe enucleation of cysts.

A
  • 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
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13
Q

Describe marsupialisation of cysts.

A
  • 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
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14
Q

Name lesions with inflammatory components.

A
  • Epiludes
  • Giant cell lesions (may resist conventional excision, may need to curettage surrounding bone and extract adjacent teeth)
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15
Q

Describe vascular lesions.

A
  • 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
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