Oral Surgery

Question 1

What should you absolutely never do when doing oral surgery

Answer 1

Dont poke it
DO PUNCH BIOPSY

Question 2

What are the rules for oral biopsy *

Answer 2

1) DO punch biopsy (never poke)
2) Take pictures before biopsy
3) Determine location of bx before imaging
4) If appropriate, get soft tissue and bone
5) Dont use laser or cautery
6) Multiple sites usually better
7) Avoid compromise of adjacent teeth or definitive surgery

Question 3

Why shouldnt you do laser or cautery when doing oral biopsy

Answer 3

because it will mess up the pathology report

Question 4

What tools are important for oral biopsy

Answer 4

tools primarily in extraction pack
1) Periosteal elevators to move gingival tissue
2) Dental elevators to remove teeth if necessary
3) 15 blade on blade holder
4) Burs to use on high speed handpiece for bone removal

Question 5

What kind of biopsy is when you removal a small section of the mass

Answer 5

Incisional biopsy - within the borders of the mass

Question 6

What kind of biopsy is when you remove all gross disease

Answer 6

excisional biopsy

Question 7

T/F: excisional biopsy is a defintive treatment while incisional is not *

Answer 7

False- neither are definitive treatment because you arent getting good margins

Question 8

Incisional biopsy is appropiate for

Answer 8

1) Large tumors
2) Tumors with a high probability of malignancy

Question 9

Excisional biopsy of oral tumors are appropriate for

Answer 9

1) Small tumors
2) Tumors attached by a stalk of tissue
3) Tumors with a high probability of being benign
4) Tumors where incisional biopsy would cause severe side effects

Question 10

Excisional or Incisional Biopsy?
Tumors attached by a stalk

Answer 10

Excisional

Question 11

Excisional or Incisional Biopsy?
Large tumors

Answer 11

Incisional

Question 12

Excisional or Incisional Biopsy?
Small tumors

Answer 12

Excisional

Question 13

Excisional or Incisional Biopsy?
tumors with a high probability of being benign

Answer 13

Excisional

Question 14

Excisional or Incisional Biopsy?
tumors with a high probability of malignancy

Answer 14

Incisional

Question 15

Excisional or Incisional Biopsy?
tumors where incisonal biopsy would cause severe side effects

Answer 15

Excisional

Question 16

T/F: benign or malignant oral tumors can be any size

Answer 16

True

Question 17

If an oral mass is irregular, does that give benign or malignant

Answer 17

Irregular = malignant feature

rounded = benign feature

Question 18

If an oral mass is pedunculated, does that give benign or malignant

Answer 18

pedunculated = benign feature

wider base = malignant feature

Question 19

If an oral mass is wider, does that give benign or malignant

Answer 19

wider base = malignant feature

pedunculated = benign feature

Question 20

If an oral mass is gingival in origin, is it more likely benign or malignant

Answer 20

Benign are most commonly gingival origin

malignant can be anywhere tho

Question 21

If an oral mass has bone destruction, does that give benign or malignant

Answer 21

malignant can have dramatic bone destruction

it is less common for benign to have bone destruction

Question 22

If an oral mass has color match of surrounding, does that give benign or malignant

Answer 22

Benign is more likely to have color that matches the surrounding tissue

malignant often has different color

Question 23

Are benign or malignant oral tumors more likely to displace the teeth

Answer 23

Malignant more likely to destroy the teeth

Question 24

How might a benign oral tumor ulcerate

Answer 24

if being traumatized

Question 25

How might a malignant oral tumor ulcerate

Answer 25

once large might ulcerate

Question 26

What are the features of benign oral tumors

Answer 26

1) Any size 2) Often Rounded 4) Often pedunculated 5) Most commonly gingival origin 6) Color matches surrounding tissue 7) might move teeth 8) ulcerated if traumatized 9) Rarely bone destruction

Question 27

What are the features of malignant oral tumors

Answer 27

1) Any size 2) Irregular shape 3) Usually wider base 4) Can be anywhere 5) Can have dramatic bone destruction 6) Less common to have color that matches surrounding tissue 7) might ulcerate when large

Question 28

T/F: melanoma has abnormal oral radiographic changes

Answer 28

False - even though it is very scary, it often doesnt have dramatic radiographic changes

Question 29

T/F: most of the time gingival masses are benigin

Answer 29

True

Question 30

What happens when you remove a peripheral odontogenic fibroma

Answer 30

it will come back you need to remove the periodontal ligament to prevent recurrence

Question 31

T/F: When you are taking biopsies of masses that are exclusive to gingiva when teeth are still intact you cannot close them

Answer 31

true- there will be bleeding

Question 32

What are types of hyperplastic oral tumors (good - just overgrowth of tissue)

Answer 32

1) Gingival hyperplasia 2) Peripheral odontogenic fibroma (POF), ossifying or fibrous - looks like cancer 3) Focal fibrous hyperplasia

Question 33

What are the odontogenic oral tumors) that cause local invasion

Answer 33

1) Peripheral odontogenic fibroma (POF), ossifying or fibrous 2) Canine acanthomatous ameloblastoma (CAA) 3) Odontoma

Question 34

What are the 3 most common non-odntogenic oral tumors in the dog

Answer 34

1) Malignant melanoma (MM) 2) Squamous cell carcinoma (SCC) 3) Fibrosarcoma (histologically low-grade. biologically high-grade)

Question 35

What is the most common oral tumor in the dog

Answer 35

Peripheral Odontogenic Fibroma

Question 36

What is another name for an epulis

Answer 36

Peripheral Odontogenic Fibroma

Question 37

Peripheral Odontogenic Fibroma features

Answer 37

1) Usually slow growing, non-ulcerated (unless its being traumatized) 2) Variable radiographic appearance based on ossifying or fibrous component 3) originates in the periodontal ligament

Question 38

Where does Peripheral Odontogenic Fibroma originate

Answer 38

The periodontal ligament

Question 39

How do you treat Peripheral Odontogenic Fibroma

Answer 39

surgical excision, may not be able to close may require extraction of the underlying tooth if it recurs

Question 40

T/F: Peripheral Odontogenic Fibroma can metastasis

Answer 40

False

Question 41

What is a radiographic sign of Peripheral Odontogenic Fibroma

Answer 41

it can grow bone into it osseous or fibrous metaplasia

Question 42

What do you tell the owner about Peripheral Odontogenic Fibroma

Answer 42

-there may be some bleeding after biopsy -typically resolves with conservative removal -if the mass re-grwos the tooth will need to be extracted

Question 43

What are the features of canine acanthomatous ameloblastoma (CAA)

Answer 43

1) Gingival mass with an irregular surface 2) Benign tumor with invasive properties but it will not metastasize 3) Can grow quickly (biopsy will make it angry) 4) Most commonly found in the rostral oral cavity

Question 44

Where is canine acanthomatous ameloblastoma (CAA) most commonly found

Answer 44

in the rostral oral cavity

Question 45

What can make canine acanthomatous ameloblastoma (CAA) grow faster

Answer 45

biopsy (it is normally fast growing

Question 46

What is a gingival mass with an irregular surface benign tumor with invasive properties will not metastasize

Answer 46

canine acanthomatous ameloblastoma (CAA)

Question 47

What margins do you need to get for canine acanthomatous ameloblastoma (CAA)

Answer 47

wide margins 1cm all around

Question 48

How do you treat canine acanthomatous ameloblastoma (CAA)

Answer 48

1) Wide surgical excision (1cm margins) prognosis is excellent with wide surgical excision

Question 49

a developmental oral tumor seen in young dogs usually associated with unerupted teeth

Answer 49

Odontoma (complex or compound)

Question 50

What are the features of Odontoma

Answer 50

1) Usually associated with unerupted teeth 2) Can be very extensive 3) Compound odontomas are associated with small tooth-like structures called denticles

Question 51

Compound odtontomas are associated with

Answer 51

Compound odontomas are associated with small tooth-like structures called denticles

Question 52

How do you treat odontomas

Answer 52

Surgical enucleation good prognosis with surgical removal

Question 53

What kinds of dogs typically get odontomas

Answer 53

young dogs - facial swelling

Question 54

If you are collecting biopsies from attached gingiva you might not be able to ______ *

Answer 54

close

Question 55

T/F: most of the tumors in the oral cavity of dogs are going to be benign

Answer 55

True but dont assume that they are