Surgical pathology

Question 1

What is the purpose of a biopsy in oral and maxillofacial pathology? “” ==

Answer 1

establish an accurate diagnosis.

Question 2

What are the key values of performing a biopsy? “” ==

Answer 2

It determines diagnosis, degree of malignancy, and prognosis.

Question 3

When is a biopsy indicated in oral lesions? “” ==

Answer 3

• premalignant
• persistent atrophic-erosive
  systemic illnesses
  vulgar pemphigus
  Benign tumors
  change in appearance
  bone expansion
  PAM BV

Question 4

What oral mucosal color changes warrant a biopsy? “” ==

Answer 4

Persistent color changes like white, red, or pigmented, especially with masses upon palpation.

Question 5

Why should maxillary cysts, particularly keratocysts, always be biopsied? “” ==

Answer 5

to determine their nature and demonstrate the relationship of nasolabial cyst to the surface of the Maxilla and to the nasal cavity

Question 6

What are some premalignant lesions that require biopsy? “” ==

Answer 6

Lichen planus, leukoplakia in atrophic-erosive areas.

Question 7

What systemic illnesses may require biopsy for diagnosis? “” ==

Answer 7

Lupus, amyloidosis, scleroderma, and Sjögren’s syndrome.

Question 8

Why is biopsy contraindicated in deep or difficult-to-access lesions? “” ==

Answer 8

Risk of damaging neighboring structures or complications from surgical access.

Question 9

Why are there contraindications for biopsy in bisphosphonate patients? “” ==

Answer 9

Risk of triggering bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Question 10

What precautions should be taken during a biopsy to prevent specimen damage? “” ==

Answer 10

get consent from Patinet
specimen to be taken from most prominnent area of lesion
anaestehsia to be given 5mm away from the specimen area
injection should be parallel to blood vessels
place specimen in 10% formaline
place specimen in x10 formaline volumen of its size
do not compress
do not tear
all parts of specimen to be sent

Question 11

What fixative is commonly used for biopsy specimens? “” ==

Answer 11

10% neutral buffered formalin, in a volume 10x that of the tissue specimen.

Question 12

How should biopsy specimens be labeled before submission to the lab? “” ==

Answer 12

Label with patient and clinician information, site, and biopsy area.

Question 13

What is the main complication of oral cavity biopsies? “” ==

Answer 13

Hemorrhage, occurring within 24 hours due to clot disruption.

Question 14

What is an incisional biopsy and when is it used? “” ==

Answer 14

A biopsy that removes only a portion of the lesion, used for larger lesions (>2 cm) or suspected malignancies.

Question 15

What is an excisional biopsy? “” ==

Answer 15

Removal of an entire lesion, typically for smaller lesions (<2 cm).

Question 16

Why should excisional biopsy incisions be made on normal tissue? “” ==

Answer 16

To ensure complete removal and proper specimen analysis without contamination from diseased tissue.

Question 17

What complications can arise from improperly sutured biopsy sites? “” ==

Answer 17

Wound dehiscence, infection, or tight sutures leading to obstruction of blood flow.

Question 18

How is fine-needle aspiration cytology (FNAC) performed? “” ==

Answer 18

Using a 23-gauge needle, cells are aspirated from deep-seated lesions, often guided by ultrasound.

Question 19

When is an aspiration biopsy indicated? “” ==

Answer 19

For cysts, fluctuant lesions, and inaccessible deep lesions where histopathology is not feasible.

Question 20

What type of fluid would indicate an odontogenic keratocyst? “” ==

Answer 20

Light yellow, cheese-like material.

Question 21

What is the significance of obtaining negative aspiration results? “” ==

Answer 21

It suggests a solid mass or latent bone cyst.

Question 22

How does oral cytology serve in biopsy procedures? “” ==

Answer 22

It is a non-invasive monitoring tool for chronic mucosal changes and screening for dysplastic lesions.

Question 23

What is the role of a fresh frozen section biopsy? “” ==

Answer 23

It is performed during surgery to assess the lesion immediately, often used for parotid tumors.

Question 24

What clinical examination techniques are used before a biopsy? “” ==

Answer 24

Inspection and palpation of the lesion for size, shape, consistency, and lymph node involvement.

Question 25

Why is lymph node examination critical before biopsy? “” ==

Answer 25

Enlarged, tender, or fixed lymph nodes can indicate infection or malignancy.

Question 26

What does a firm, rubbery lymph node suggest? “” ==

Answer 26

It suggests lymphoma.

Question 27

Why should suction be minimized during biopsies? “” ==

Answer 27

It can increase bleeding and risk of aspirating the biopsy tissue sample.

Question 28

Why should laser and electrosurgical devices be avoided during biopsy? “” ==

Answer 28

They can cause tissue distortion, making histological analysis difficult.

Question 29

What tools are used for biopsy harvesting once an osseous window is created? “” ==

Answer 29

Spoon curette, Allis forceps, or grooved chisel.

Question 30

How should soft tissue overlying intraosseous lesions be handled post-biopsy? “” ==

Answer 30

Re-approximated after thorough irrigation of the operative site.

Question 31

What is the primary method for creating an osseous window in bone biopsy? “” ==

Answer 31

Using a round surgical bur with constant irrigation or bone rongeurs for eroded cortical plates.

Question 32

What precautions should be taken in tissue specimen management? “” ==

Answer 32

Specimen should not be allowed to dry or be crushed and must be fully immersed in formalin.

Question 33

What information must be included in the specimen report? “” ==

Answer 33

Patient details, medical history, lesion history, clinical diagnosis, biopsy site, and differential diagnosis.

Question 34

What diagnostic imaging is often used for soft tissue lesions in oral pathology? “” ==

Answer 34

MRI, as it is better for visualizing soft tissue detail.

Question 35

Why is follow-up critical after an incisional biopsy? “” ==

Answer 35

To re-evaluate the lesion once the microscopic diagnosis is available and plan further treatment.

Question 36

Why should aspiration be performed before an incisional biopsy of a lesion? “” ==

Answer 36

To rule out the possibility of the lesion being vascular or containing fluid.

Question 37

What is the role of radiographs in oral pathology diagnosis? “” ==

Answer 37

To assess the extent and nature of osseous lesions, providing a basis for further biopsy if needed.

Question 38

What is the potential complication of deep-seated tumor biopsies in major salivary glands? “” ==

Answer 38

Risk of damaging critical structures and spreading tumor cells.

Question 39

How should wound closure be handled after excisional biopsy on non-suturable sites? “” ==

Answer 39

Apply surgical dressing, allowing the wound to heal by secondary intention.

Question 40

What are the postoperative care instructions following a biopsy? “” ==

Answer 40

Standard oral surgery instructions, including wound care, avoiding trauma, and monitoring for complications.