ORAL SURG referral to oral med and biopsy Flashcards
List when to refer to oral medicine?
red/white patches (suspected leukoplakia)
erosions/ ulcers (autoimmune)
vesiculobullous lesions
burning mouth syndrome
facial pain
xerostomia (salivary gland biopsy)
what is a biopsy?
the removal of tissues for histopathological examination
- mucosa
- bone
- curettage of cyst linings/ contents
what type of lesions would we therapeutically biopsy?
benign lesions
- fibroepithelial polyps
- papillomas
- denture induced hyperplasia
what is an excisional biospy?
take the whole lesion away
what is an incisional biopsy?
sample a piece of the lesion
what are the 3 types of incisional biopsies?
exfoliative cytology
aspirational (FNAC)
labial gland biopsy
what lesions would be excised therapeutically?
small, benign lesions
what causes a mucocoele?
trauma - damage to salivary duct
treatment of a mucocoele? and what must you warn the pt?
excise its entirety and salivary gland at the base
*warm pt that it will leave a small scar and area of numbness
what happens to a mucocoele when it bursts?
it fibroses and becomes more fluctuant and persistent
what is an epulis?
swelling on the gum
what type of lesion is a pyogenic granuloma?
soft tissue inflammatory lesion
what is a common cause of pyogenic granuloma?
chronic irritation i.e., ledge of amalgam
treatment for pyogenic granuloma?
excise and send for histological examination
areas will heal with granulation tissue
treatment for leaf fibroma?
LA and cur through stalk to remove
what is a leaf fibroma?
benign overgrowth - developed from a small pedunculated stop
what type of lesions would you take an incisional biopsy of?
when presumptive diagnosis is:
- vesiculobullous
- lichen planus
- potentially malignant
when would you take a mapping biopsy?
red and white speckled (different appearances)
several sites
Field change
what are the high risk sites in the mouth for oral cancer?
ventral tongue
FOM
lateral tongue
soft palate
when taking a biopsy of suspected cancer, where do you cut?
the worst looking part
when removing cancer, what measurements are significant?
cancer plus 1mm around each side
what instruments can be used for biopsy?
standard soft tissue tray
diathermy
punch biopsy
CO2 laser
cryotherapy
what is diatherpy?
instrument use to take a biopsy of a large lesion which sends electric currents whilst cutting which also seals the cut
useful in highly vascularised areas
when would you take a punch biopsy?
small lesion
what size must punch biopsy be and why?
at least 6mm as shrinks when placed in saline
what is a CO2 laser for biopsy?
used for excision of extensive lesions- seals the blood and lymphatic vessels as it cuts
good haemostasis and post op swelling
used for management of lesions
when would you use cryotherapy?
vascular lesions such as haemangiomas
why do samples shrink in saline?
protein gets deproteinised
once a biopsy is taken where is it placed and what is the journey?
saline
transported to the pathologist to be embedded in wax, sectioned into 4um slices, stained with H+E, then looked at down microscope
when using the CO2 laser for excision, why must instruments be covered?
so they dont reflect and refract - burn something
when taking a biopsy, what shape of tissue do we take?
wedge shaped - sample underlying soft tissue
list problems that can occur with biopsy taking?
inappropriate specimen
specimen too small or macerated
cant orientate specimen
tissue distorted by diathermy or LA
lab not informed of need for frozen section
lack of clinical detail on form
specimen gone up aspirator
why do you send frozen biopsies?
allows for rapid diagnosis of malignancy - to exclude malignancy at time of surgery
result within 1hr
required for direct immunofluorescence - vesiculobullous
what is exfoliative cytology?
removal of surface cells by scraping with a spatula or cytobrush
widely used in cervical cancer screening
when is fine needle aspiration cytology used?
determine whether lesion is solid or cystic/ fluid filled
useful with lumps in the parotid glands and neck lumps to determine whether the lump is a tumour
when is true cut biopsy used?
to allow a core of tissue to be harvested - neck lumps
when would you take a labial gland biopsy?
diagnosis of sjogrens syndrome
what investigation would be used for parotid tumours?
ultrasound
why is a labial gland biopsy taken to investigate sjogrens?
pathological changes within minor glands mirror that of major glands
what are diagnostic aids which arent used anymore?
Toluidine blue
Vizlite (still used as an adjunct)
VELscope
