dental lesion and its affects on the treatment of patient.pptx

a brief seminar about the types of biopsy that's used in dental practice.

1. Biopsy in Oral surgery By: Dr. Mustafa Qasim Supervised by: Dr. Batool

2. Analysis of lesional Tissue Histological examination (Biopsy) Immunopathologic /antigen*antibody reaction Mol ecular evaluation /advanced

3. Biopsy is a sample of tissue taken from a patient for histopathological examination

4. Bio psy types Fine needle aspiration Incisional biopsy Excisional biopsy

5. Other biopsysis Punch biopsy e.g tumor of internal organs Cytological smears e.g. oral mucosal Cancer (oral brush biopsy) Frozen section biopsy

6. Indication for oral biopsy?

7. is indicated for the assessment of any unexplained oral mucosal abnormality that persists despite treatment or the removal of local irritants.

8. Why?

9. Malignancy is suspected when persistent oral mucosal lesions are red or red and white or when they are ulcerated, indurated, or fixed to deeper tissues.

10. Persist hyper keratotic change in surface tissue Any persist tumescence , either visible or palpable beneath relatively normal tissue Lesions interfere with local function Bone lesions not specifically identify by clinical and radiographic findings. Any lesions have characteristics of malignancy .

11. Erythroplasia lesions is totally red or have refd speckled appe arance Ulceration lesions-ulcerated persist for more than 2 weeks. Growth rate-lesion excehpets rapid growth Bleeding lesions on gentle manipulation Induration-Lesions and surrounding tissue firm to touch Fixation-lesion feels attached to adjacent structures

12. Contraindications

13. Oral mucosal biopsy has few contraindications. The standard biopsy techniques may require modification in some patients, including those with conditions that preclude the safe use of local anesthetic and those with severe bleeding diatheses or coagulopathies.

14. Invasive procedures that may stimulate bone should be avoided when possible, or conducted with great caution in patients who have used or are currently using injectable bisphosphonates.

15. Mucosal lesions in these individuals may be reflective of underlying medication-related osteonecrosis of the jaws (MRONJ), a condition that may be exacerbated by any manipulation. Caution should also be taken with lesions that appear vascular, especially when there is a palpable pulsation or bruit.

16. Pigmented lesions (melanoma) should not be biops ied as it may transfeorm into malignant by cutting through it or may spread to distance organs

17. Not advi sed in case of multiple neurofibroma, due to risk of neurosarcomotus transformation or in tumors of major salivary glands.

18. Oral biopsy not needed in Normal structure s Inflammatory or infectious lesions that respond to specific local treatment's, as pericoronitis, gingivitis No incisional biopsysis should be performed on suspected angiomatous lesions

19. Objectives of biopsy Conf irm diagnosis made on clinical findings Determine treatment plan Valuable self teaching diagnostic aid Medical record

20. Most susceptible lesions seen in oral cavity: 1- Leukoplakia (friction al keratosis ): It is white patch it is not a histologic diagnosis. It is a clinical description “white patch or plaque that cannot be wiped off nor characterized clinically or pathologically as any other disease.”

21. 2-oral candidasis (oral mycosis, moniliasis): An infection of the oral cavity caused by a fungal organism The most common fungal organism present in the oral cavity is Candida albicans. *Widespread white candidal plaques. * erythematous ulcerated candidal infection

22. * Candidiasis of the dorsum of the tongue in a patient with vitamin B deficiency.

23. 3-Irritation Fibroma (Focal fibrous hyperplasia, keloid): Exuberant scar tissue. Irritation fibroma occurs due to acute or repeated trauma to an oral site.

24. 4-Malignant salivary gland neoplasm: Malignant salivary gland neoplasm of the right palate. The lesion is raised, ulcerated, and firm to palpation. This lesions is always miss leading with Abscess so try to evacuated it then it Seeding it malignancy cell in all over The place

25. 5-Squamous Papilloma: benign epithelial proliferation that has papillary architecture.

26. Equipment Biopsy of soft tissue lesions can usually be performed with the following equipment. Local anesthetic with vasoconstriction agen 15-blade or similar incisional device Toothed forceps Small dissecting scissors Suction with a small tip Gauze Suture material for wound closure and specimen marking Electrocautery device should be readily available

27. Equipment for hard tissue biopsy Bony lesions often require extensive preoperative planning, and the decision between an incisional or excisional biopsy is typically made during the procedure. In addition to the instrumentation required for a soft tissue biopsy, burrs for entering the bone, a needle and syringe to aspirate the bony lesion and hemostatic agents are required when biopsying a hard tissue lesion.

28. Spic emen transport Specimens requiring routine formal histopathological evaluation should be placed in formalin If an underlying immunological issue is suspected, such as lichen planus, pemphigus vulgaris, or lupus, a separate tissue sample should be obtained for direct immunofluorescence and placed in Michel solution. Biopsies requiring immunological evaluation should be discussed with the pathologist before initiating the procedure. If the biopsy is performed in a facility with an onsite pathologist, evaluation of a frozen section may be possible to rule out malignancy intraoperatively

29. Types of biopsy

30. Fine needle aspiration is a procedure healthcare providers use to get a cell sample from a suspicious lump or an abnormal area of your body. It's also called a fine-needle biopsy. FNA involves using a thin needle and a syringe to pull out cells, tissue and fluids

31. Ind ications Non palpable lesions, or area difficult to Biopsy but can be localized by CT, MRI, Ultrasound. To rule out vascular lesions prior to open surgery In cases where Biopsy is contraindicated on medical background. Indicated for known tumours to assess effect of treatment. Used to obtain tissue for specific studies.

32. Techni que FNAC with aspiration FNAC without aspiration: it is based on observation that the capillar y pressure in a fine needle is sufficient to keep the detached cell inside the lumen of the needle.

33. Advantage This t echnique is relatively painless, produce rapidly results. It is requir little equipment. Can be done as an out patient or a bed side procedure. There is no problem with wound healing. The technique is rapidly repeatable.

34. This technique is only desecremenat if this cell have character of mal ignancy or not And it's not determine the type of malignancy.

35. 2.incisional biopsy A surgical procedure in which a cut is made through the skin to remove a sample of abnormal tissue or part of a lump or suspicious area. The tissue is then checked under a microscope for signs of disease

36. *ind ications: Size limitations Hazardous location of the lesions Great suspecous of malignancy *Disadvantage: Crush, split, and hemorrhage are the most frequently found in incisional biopsys Theoretical seeding of cancer cells into the adjoining tissues

37. Technique Representative area are biopsied in wedge fashion. Margin should extended in normal tissue on the deep surface. Necrotic tissue should be avoided. Narrow deep specimen is better than broad shallow one.

38. 3.excisional biopsy A surgical procedure in which a cut is made through the skin to remove an entire lump or suspicious area so it can be checked under a microscope for signs of disease. A small amount of healthy tissue around the abnormal area may also be removed

39. Ind ications: Small lesions less than 1cm The lesions on clinical exam appear benign When excision with a margin of normal tissue is impossible without mutilation

40. *technique: The entire lesions with 2to 3 mm of normal appearing tissue surrounding the tissue excised if benign El liptical incision is carried out allowing for a narrow rim of nor peripheral tissues. Bevelling the incision to a narrow “v” base facitlates wound closure

41. 4.punch biopsy procedure in which a small round piece of tissue about the size of a pencil eraser is removed using a sharp, hollow, circular instrument. The tissue is then checked under a microscope for signs of disease

42. 5.oral brush biopsy The brush biopsy technique allows quick evaluation of questionable lesions that clinically do not appear to be malignant, and may thus increase the likelihood of biopsy in these cases and hasten the diagnosis of malignancies that might otherwise remain undiscovered until a later time

43. It is considered as non invasive method Of determinaing presence atypia cell

44. *technique: Th e brush is rotated under slight pressure several times on the suspecous lesions Immediately smeared on glass slides and fixed with alcohol spray

45. 6-Exfoliative cytology It is quick and simple procedure, it is important alternative of biopsy in certain situations Cell shed from body surface s, such as in side mouth are collected and examined *Indications: Large diffuse or multiple lesions Urgent result is required Patient is not indicated for surgery *Technique: Scrap the lesions with stainless steel spatula or moistened tongue depressor Cell smeared on glass slide

46. Frozen section This technique is allowed to stain slide within 10 minutes for examined after taking the spic emen. It is frozen by immersion in liquid nitrogen it is about -70 A section is then cut on a refrigerated microtome and stained. We could use this method for intra operative to leading us for boundary of the lesions

47. *dangers of biopsy: Spreading of infections Hemorrhage Infections Operative trauma

48. Biopsy data sheet containet: Patient data History Clinical description Nature of biopsy Radiographs and photographs Description of biopsy specimen

49. Biopsy report include: Name of clinician Date of specimen was obtain Pertinent characteristics of the specimen The location /site ,size, color, number,borders or margins, consistency and relative radiolucency of the lesions

50. *Artifact: It is alteration in the tissue morphology that results from various from of mechanical, chemical or thermal insult to the tissue specimen removed for diagnostic purpose , anywhere from fixation to processing to staining

51. Injection of L.A in to the lesion Improper handling of the tissue like : Error during manipulation of tissue Heat artifact Foreign bodies or starch artifact

52. Thank you.