ORAL SURG referral to oral med and biopsy

Question 1

List when to refer to oral medicine?

Answer 1

red/white patches (suspected leukoplakia)
erosions/ ulcers (autoimmune)
vesiculobullous lesions
burning mouth syndrome
facial pain
xerostomia (salivary gland biopsy)

Question 2

what is a biopsy?

Answer 2

the removal of tissues for histopathological examination
- mucosa
- bone
- curettage of cyst linings/ contents

Question 3

what type of lesions would we therapeutically biopsy?

Answer 3

benign lesions
- fibroepithelial polyps
- papillomas
- denture induced hyperplasia

Question 4

what is an excisional biospy?

Answer 4

take the whole lesion away

Question 5

what is an incisional biopsy?

Answer 5

sample a piece of the lesion

Question 6

what are the 3 types of incisional biopsies?

Answer 6

exfoliative cytology
aspirational (FNAC)
labial gland biopsy

Question 7

what lesions would be excised therapeutically?

Answer 7

small, benign lesions

Question 8

what causes a mucocoele?

Answer 8

trauma - damage to salivary duct

Question 9

treatment of a mucocoele? and what must you warn the pt?

Answer 9

excise its entirety and salivary gland at the base

*warm pt that it will leave a small scar and area of numbness

Question 10

what happens to a mucocoele when it bursts?

Answer 10

it fibroses and becomes more fluctuant and persistent

Question 11

what is an epulis?

Answer 11

swelling on the gum

Question 12

what type of lesion is a pyogenic granuloma?

Answer 12

soft tissue inflammatory lesion

Question 13

what is a common cause of pyogenic granuloma?

Answer 13

chronic irritation i.e., ledge of amalgam

Question 14

treatment for pyogenic granuloma?

Answer 14

excise and send for histological examination
areas will heal with granulation tissue

Question 15

treatment for leaf fibroma?

Answer 15

LA and cur through stalk to remove

Question 16

what is a leaf fibroma?

Answer 16

benign overgrowth - developed from a small pedunculated stop

Question 17

what type of lesions would you take an incisional biopsy of?

Answer 17

when presumptive diagnosis is:
- vesiculobullous
- lichen planus
- potentially malignant

Question 18

when would you take a mapping biopsy?

Answer 18

red and white speckled (different appearances)

several sites

Field change

Question 19

what are the high risk sites in the mouth for oral cancer?

Answer 19

ventral tongue
FOM
lateral tongue
soft palate

Question 20

when taking a biopsy of suspected cancer, where do you cut?

Answer 20

the worst looking part

Question 21

when removing cancer, what measurements are significant?

Answer 21

cancer plus 1mm around each side

Question 22

what instruments can be used for biopsy?

Answer 22

standard soft tissue tray
diathermy
punch biopsy
CO2 laser
cryotherapy

Question 23

what is diatherpy?

Answer 23

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

Question 24

when would you take a punch biopsy?

Answer 24

small lesion

Question 25

what size must punch biopsy be and why?

Answer 25

at least 6mm as shrinks when placed in saline

Question 26

what is a CO2 laser for biopsy?

Answer 26

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

Question 27

when would you use cryotherapy?

Answer 27

vascular lesions such as haemangiomas

Question 28

why do samples shrink in saline?

Answer 28

protein gets deproteinised

Question 29

once a biopsy is taken where is it placed and what is the journey?

Answer 29

saline
transported to the pathologist to be embedded in wax, sectioned into 4um slices, stained with H+E, then looked at down microscope

Question 30

when using the CO2 laser for excision, why must instruments be covered?

Answer 30

so they dont reflect and refract - burn something

Question 31

when taking a biopsy, what shape of tissue do we take?

Answer 31

wedge shaped - sample underlying soft tissue

Question 32

list problems that can occur with biopsy taking?

Answer 32

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

Question 33

why do you send frozen biopsies?

Answer 33

allows for rapid diagnosis of malignancy - to exclude malignancy at time of surgery

result within 1hr

required for direct immunofluorescence - vesiculobullous

Question 34

what is exfoliative cytology?

Answer 34

removal of surface cells by scraping with a spatula or cytobrush
widely used in cervical cancer screening

Question 35

when is fine needle aspiration cytology used?

Answer 35

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

Question 36

when is true cut biopsy used?

Answer 36

to allow a core of tissue to be harvested - neck lumps

Question 37

when would you take a labial gland biopsy?

Answer 37

diagnosis of sjogrens syndrome

Question 38

what investigation would be used for parotid tumours?

Answer 38

ultrasound

Question 39

why is a labial gland biopsy taken to investigate sjogrens?

Answer 39

pathological changes within minor glands mirror that of major glands

Question 40

what are diagnostic aids which arent used anymore?

Answer 40

Toluidine blue
Vizlite (still used as an adjunct)
VELscope