General dentistry

Indications Unusual and persistent oral mucosal abnormality despite removal of surrounding irritants and treatment, is indicative of a biopsy. These persistent lesions could bleed and grow rapidly imply suspected malignancy. The lesions are indurated and ulcerated, fixed deep into the tissues and are red or white in colour.

ApproachThere are several methods of sample tissue collections for histopathologic examination, from the oral mucosa. A standard scalpel biopsy can give a satisfactory specimen to perform a biopsy. Other means adopted are needle biopsy, punch biopsy, laser, biopsy punch and electrocautery devices. Comprehensive oral examinations routinely involve several diagnostic tests which provide ancillary information for a definitive diagnosis and treatment procedure.

Fine needle aspiration cytologyA fine needle aspiration cytology would be invited when a neck mass cannot be explained by mere physical examination. A prudent examination of the upper aerodigestive tract consisting of the larynx, nasopharynx and hypopharynx is warranted if the lesion believed to be metastatic. Topical or infiltrative anaesthesia is administered on the overlying skin. Larger needles or the common 21-guage needle attached to a custom 10 mL disposable syringe holders are used. As a simple clinical procedure, FNA is accurate when sufficient cells for examination are obtained

Incisional biopsyAn incisional biopsy aims to define a lesion on the basis of its histopathological aspect and establish prognosis of suspicious malignant and premalignant lesions. A most representative sample of the lesion is attained along with some peripheral normal tissues and intact mucosa is taken to make a definitive diagnosis. Incisional biopsies are performed on large ulcerated lesions with a long axis greater than 1cm. Diagnostic abilities are enhanced by staining the mucosa with toluidine blue or tolonium chloride dye which stains only the affected mucosa leaving the other areas intact.

Excisional biopsyA lesion may be removed in its entirety provided the differential diagnosis is a benign entity. Excisional biopsy includes the usage of a suction device which has to be used with caution to prevent inadvertent loss of lesion. The decision to perform an excisional biopsy is driven by the size of the lesion, its location, nature of attachment to underlying tissue, the regional anatomy and its accessibility. Local anaesthetics applied are regional or field blocks through infiltration of peripheral area of the lesion. After stabilizing the oral mucosa, the two ellipsical incisions are made all around the lesion. A wedge-shaped specimen is collected and the wound left behind is easy to close.