Management of Soft Tissue Lesions Flashcards
Characterisation of swelling (5S 2C)
Site Size Shape Surface (ulcerated/smooth) Structures Colour Consistency (firm/fluctuant)
Clinical presentation and exam of swellings
- take thorough history and be systematic
- When did the lesion first appear
- Is it recurrent
- Family history of such lesions
Why do we need to do special investigations and what investigations can we do?
- To help distinguish between benign and malignant conditions
- Imaging (X-ray, MRI, CT, Ultrasound)
- Blood screen (Lymphoma or Kaposi)
- Sensibility testing of associated teeth
- Biopsy
Indications for removal of benign lesion
- Pain, function, aesthetics, continual growth, pressure of adjacent structures, weakening of structures
- Confirm diagnosis and ensure it is not malignant
- Always exclude neoplasia - urgent 2 week referral
Biopsy techniques
- excisional: complete removal with surrounding normal tissue
- Incisional: diagnostic; removal of portion of lesion
- Punch: removal of core - better for healing
- Fine Needle Aspiration (FNA) - aspiration of fluid/tissue of deep lesions
- Cytology: examination of cells under microscope - sample can come from anywhere including brush biopsy
Biopsy pathology request should include:
date of specimen pt details clinical information (history, exam, previous tx) differential diagnosis investigations (microbial, radiology) specimen details investigations required risk factors (smoking, alcohol) contact details of surgeon
LASER (Light Amplification by Stimulated Emission of Radiation) - what does it do
- Cutting: tissue vaporisation from heating cells to boiling point
- Coagulation: protein denaturation results in cell death and Haemostasis
- need lasing medium (gas/aqueous/crystalline), electromagnetic energy and systemic of optical amplification
- No LA needed and less blood loss but needs complex equipment
Cryotheraphy: how does it work
- Tissue denaturation using cold medium
- Ice-ball is formed resulting in expansion of cell volume and disruption occurs on thawing
- Repeated cycles of freeze thawing reduce cell mass of lesion
- Good for fluid filled lesions
- No cutting involved but ulceration and large amount of swelling post op and needs complex equipment
Management of fibroepithelial polyp
remove cause
excision
Management of denture induced hyperplasia
adjust denture area
new denture
surgical excision
Management of pyogenic granuloma
remove cause
excision
pregnancy epulis: monitor or excision (may recur)
Management of Giant cell epulis
Check extent on radiograph
excision of lesion and curettage region
bloods check for hyperparathyroidism
Management of papilloma
local excision surgically
Management of lipoma
surgical excision: removal of capsule surrounded by layers of CT
does not recur
Management of Haemangioma
- Do not biopsy due to lots of bleeding
- Confirm diagnosis with ultrasound
- Cryosurgery or laser surgery ± prior injection of scleroisng solutions
- Monitor in children
