Surgical Management of Benign and Cystic Lesions

Question 1

What are some indications for the removal of benign lesions?

Answer 1

Pain

Function

Aesthetics

Continual Growth

Pressure on adjacent structures

Weakening of structures

Infection

Question 2

What is this procedure called?

Answer 2

Elliptical Excisional Biopsy

Question 3

If a lesion is too big to cut around what can be done instead?

Answer 3

An incision can be made over the lesion and the lesion dissected out

Question 4

What is Enucleation?

What sites would you carry this out on?

Answer 4

Removal of the lesion with the lining, usually followed by wound closure

Soft tissue or encased in bone

Question 5

What is Marsupialisation?

Answer 5

Decompression of the cyst by creating the largest possible surgical window consistent with the surrounding anatomy.

Question 6

Give some advantages of Enucleation/Marsupialisation

Answer 6

Cyst cavity closed to mouth

Little aftercare needed

Complete lining available for histological examination

Question 7

Give some disadvantages of Enucleation/Marsupialisation

Answer 7

Clot in cavity may get infected

Incomplete removal- recurrence

Haemorrhage

Patient needs to keep area clean

Question 8

How do you treat Salivary Gland Obstructions/Stones?

Answer 8

Surgical removal incising through the duct wall to remove the stone

Question 9

What does LASER stand for?

Answer 9

Light Amplification by Stimulated Emission of Radiation

Question 10

What are some advantages of using LASERs for surgical removal of cysts?

Answer 10

Dry surgical field

Reduction of blood loss

Reduction of post-operative oedema, pain and fibrosis

Question 11

What are some disadvantages of using LASERs for surgical removal of cysts?

Answer 11

Cost

Complexity of equipment

No pathology specimen

Question 12

What is monopolar diathermy?

Answer 12

Current generated passed from instrument tip through patient and is earthed via the common electrode plate

Question 13

What is bipolar diathermy?

Answer 13

Current passes from one instrument tip to another via a small volume of tissue

Question 14

What is Cryotherapy?

Answer 14

Tissue denaturation using application of cold medium is employed

Question 15

What are some advantages of cryotherapy?

Answer 15

No cutting involved

Tissue intact at end of procedure – no bleeding (haemangioma)

Can do without LA (but kinder with LA)

Excellent with fluid filled lesions

Question 16

What are some disadvantages of cryotherapy?

Answer 16

Cost of equipment

No pathology specimen

Large amount of swelling post op, as adjacent tissues which cooled down suffer partial damage

Ulceration post operatively