L16 Surgical management of common benign dentoalveolar lesions Flashcards
What features may a lesion present with?
- Presence of swelling
- Change in colour and texture
- Breakdown of overlying mucosa
- Asymmetry related to sub mucosal changes e.g. bone
What should you include when describing a lesion?
- Site
- Size
- Shape
- Surface
- Structures
- Superficiality
- Colour
- Consistency
What methods could be used to diagnose a lesion?
- Radiographs
- Diagnostic biopsy
- Lab investigations e.g. pathology, microbiology, haematology
What does fluctuance mean?
A fluid filled lesion.
- Possibly contains pus, blood or cystic fluid
- Cyst contents tend to be clear
- Blood could indicate a haemangioma
What is a culture and sensitivity test?
- Sample of lesion is cultured on agar plate and identified
- Sensitivity to different antibiotics is checked, appropriate abx prescribed
Describe the various biopsy types.
- 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)
What type of LA is used during a biopsy?
- 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
What information do you need to provide the pathologist with?
- 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
How is denture-induced hyperplasia treated?
- 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
What is a cyst?
A pathological epithelial lined cavity filled with fluid.
Cysts in the oral region are most commonly tooth related (70%).
How are cysts managed?
Must remove contents of cysts, encourage healing and stimulate remodelling.
2 options:
- Encucleation
- Marsupialisation
Describe enucleation of cysts.
- 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
Describe marsupialisation of cysts.
- 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
Name lesions with inflammatory components.
- Epiludes
- Giant cell lesions (may resist conventional excision, may need to curettage surrounding bone and extract adjacent teeth)
Describe vascular lesions.
- 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