L13 - Biopsy of hard and soft tissue

Question 1

outline excisional biopsy

Answer 1

border

elliptical incision with length of the incision around 3x

undermining tissue layers for tension free closure

wedge biopsy (basically an elliptical biopsy with 3rd dimension of depth)

local anatomy consideration in planning biopsy

marking margins of specimen

Question 2

if incisional biopsy

Answer 2

elliptical incision technique

location of biopsy crucial to obtain diagnostic information

Question 3

in general of ulcer

biopsy

Answer 3

• incisional

biopsy periphery of ulcer at the margin of normal and abnormal tissue

Question 4

in general of solid tumor mass

biopsy

Answer 4

incisional biopsy

- biopsy CENTER of solid tumor mass staying away from margin of lesion

Question 5

basic instrumentation

Answer 5

scissors - used for sharp and blunt dissection

tissue holding forceps

claps-hemostats

electrocautery

Question 6

when to perform a soft tissue biopsy

1-5

Answer 6

1. ulceration that fails to heal despite removal of irritant
2. extraction socket that does not heal despite more then adequate time
3. tissue that fails to respond to adequate routine dental hygeine measures
4. persistent red / white disease
5. unexplained pigmented lesions which do not blanch on pressure

Question 7

3 examples of specialized common soft tissues biopsies

Answer 7

1. marsupialization for ranula
2. lips- lining up cutaneous-vermilion border
3. vesicullo-bullous lesion

Question 8

vesicullo- bullous lesion

Answer 8

1. periphery of ulcer
2. consider uninvolved or attached gingival sites to biopsy
3. special storage media for specimen

Question 9

what not to biopsy

Answer 9

1. geographic tongue
2. fordyce granules
3. the occasional apthous ulcer
4. median rhomboid glossitis
5. recurrent intra-oral herpetic lesions

Question 10

when to consider biopsy of boney lesions

Answer 10

1. parasthesia
2. unusual unexplained root resorption
3. unexplained tooth displacement
4. atypical / asymmetric marrow pattern

Question 11

block resection for radiolucent

Answer 11

for large aggressive lesions

Question 12

marginal resection for radiolucent

Answer 12

consider with multilocular or more aggressive odontogenic lesions

Question 13

pathology diagnosis starts with ..?

Answer 13

patient history and a good exam

Question 14

what type removes the whole thing

Answer 14

excisional biopsy

surorund with normal border of tissue

Question 15

biopsy what with ulcer

Answer 15

the peripheray of it not the center

Question 16

incisional biopsy - general

Answer 16

taking a little bit

relatively narrow and relatively deep

Question 17

desirable shape for incisional biopsy

Answer 17

deep and narrow

NOT broad and shallow

Question 18

basic biopsy intrusments

Answer 18

hemostat and currette

Question 19

diagram of excisional biopsy

Answer 19

elliptical for closure

below submucosal layer

suture closed primarily

Question 20

circular incsision?

Answer 20

NO – cant close

Question 21

length and width of excisional biopsy

Answer 21

roughly 3x longer than it is wide

Question 22

fluid filled lesion - history of trauma

been there for awhule

Answer 22

mucocele
elliptical incision
going beyond where lesion is

separate from underlying muscle layer

Question 23

remove additional minor salivary gland tissue?

Answer 23

yes – because mucocele has potential to come back

Question 24

achieving hemostasis

Answer 24

do this before you suture closed

Question 25

how to get tension free closure

Answer 25

undermine mucosal edges - so undermine the tissue before suture if dont - sutures can pull open

Question 26

descrete non -indurated lesion on dorsal tongue | excisional or incisional?

Answer 26

excisional biopsy - likely a viral lesion on the tongue like a papilloma

Question 27

what do you have to do before make incision on the tongue?

Answer 27

traction suture - controls the position of the tongue | - to be able to keep the tongue open

Question 28

lesion on outside of tongue - what type of suture

Answer 28

inverted vicryl sutures

Question 29

picture for incisional vs excisional firm mass on buccal vestibule well circumscribed maybe fibroma? neurofibroma?

Answer 29

structure near by? | - mental nerve parasthesia -- bicuspid area

Question 30

large exophytic ulcer on lateral ventral aspect of the tongue papible cervical lymph node soreness is present incision where?

Answer 30

fungal / cancer? biopsy - AT THE MARGIN OF IT NOT THE CENTER - filled with acute and chronic inflammatory cells -- not good biopsy

Question 31

former 'smokers patch' can become

Answer 31

invasive squamous cell carcinoma

Question 32

biopsy smokeless tobacco patch

Answer 32

yes

Question 33

unexplained pigmented lesions

Answer 33

unexplained area -- biopsy

Question 34

non-healing extraction sockets

Answer 34

yes -- needs to be biopsied after 8 weeks - needs to be excised

Question 35

tissue that does not respond to therapy

Answer 35

biopsy prevent late gingival carcinoma

Question 36

red/ whire lesion with non healing ulcer

Answer 36

lichen planus erosive lichen planus - low risk of malignancy but still have to biopsy

Question 37

fibro-vascular lesion? implication

Answer 37

needs to be biopsied - likely to bleed usually requires electro-cautery - if dont have these might rethink

Question 38

pregnant ? what to do first?

Answer 38

get lab tests first

Question 39

large mass hard / soft palate firm dome shaped

Answer 39

excisional biopsy - borders extend beyond the mass - subperiosteal disection - to the hard palate - obturator made

Question 40

ranula marsupialization technique

Answer 40

scissors to create a incisiaonl spread - take out whole thing - take care of bleeding - undermining tissue -- no tension - suture

Question 41

firm mass biopsy where / no ulceration where incisional

Answer 41

CENTER | -

Question 42

mucosal stripping? ventral lateral tongue | non-indurated (soft)

Answer 42

excisional - removed it all - using the traction control suture because on tongue

Question 43

wedge resection technique

Answer 43

3-D - lips most of the time - orient the vermillion border - deeper

Question 44

vesiculobullous lesion

Answer 44

+ nikolsky sign sloughing of tissue like pemphigus may take biopsy in two sites - not in the center - may use some normal tissue too topical steroids and anti-fungal agents

Question 45

non-healing ulcer at least - pain vs painless ulcer

Answer 45

6 weeks non healing -- be worried about this - but may not be cancer - but needs to be biopsied painless - insitu cancer

Question 46

trauma and ulcer

Answer 46

remove the trauma - allow to heal -- if does not heal - then decide to biopsy

Question 47

lesions we do not biopsy - he noted on the palate

Answer 47

small little red dots -- because we have history of multiple palatal injections

Question 48

shallow ulcer with erythematous base? | ask them what?

Answer 48

eat something hot?? -- burn | dont need to biopsy

Question 49

acute candidiasis?

Answer 49

dont need to biopsy

Question 50

large uleration on tongue - lateral

Answer 50

could be viral | primary syphalis

Question 51

molt currette

Answer 51

for bony lesions

Question 52

general rule for curette use

Answer 52

used on lesions which are well defined on x-ray

Question 53

incisions for bony lesions where - in general

Answer 53

must lie over solid bone limit chance of complications like communication with sinus and nasal cavity

Question 54

cyst in the maxilla? displace to

Answer 54

can displace into sinus and nasal cavity

Question 55

what to do with all large cystic radiolucencies?

Answer 55

ASPIRATE - rule out a central vascular lesion why? - wont be able to stop the bleeding

Question 56

removal technique for bigger lesions like an ameloblastoma

Answer 56

do an incisional biopsy first to know what dealing with block incision - normal bone periphery included in specimen about 1.5 cm away from lesion - like this normal has to come out with it

Question 57

fiibro-osseous lesions use

Answer 57

punch biopsy

Question 58

unexplained root resorption?

Answer 58

biopsy the peri-apical tissue when do extraction

Question 59

general principles of radio-opaque fibro-osseouos lesions?

Answer 59

1. biopsy central of lesion - punch biopsy technique - minimal periosteal elevation 2. bone shave / recontouring for very large lesions of fibrous dysplasia