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1、<p><p>&lt;p&gt;Principles of Tissue Biopsy in Oral and Maxillofacial Surgery Speaker: 黃傳貴 大夫 Moderator:雷文天 大夫 Examination &amp;amp; Diagnostic Methods Health history History of the lesion Clinical examination Radiographic examination Laboratory investigati
2、on Biopsy Definition of Biopsy Removal of tissue from a living individual for diagnostic examination Indication for Biopsy Any lesion persists for more than 2 weeks with no apparent etiology basis Any inflammatory lesion that does not respond to local treatment after 10 to 14 days (that is,after rem
3、oving local irritant) Indication for Biopsy Persistent hyperkeratosis changes in surface tissue (ex:lips or oral mucosa) Any persistent tumescence,either visible or palpable beneath relatively normal tissue Lesion that interfere with local function (ex:fibroma) Indication for Biopsy Bone lesions not
4、 specifically identified by clinical and radiographic finding Any lesion that has the characteristics of malignancy Characteristics of lesions that raise the suspicion of malignancy Erythroplasialesion is totally red or has speckled red appearance Ulcerationlesion is ulcerated or presents as an ulce
5、r Duration lesion has persisted more than 2 weeks Characteristics of lesions that raise the suspicion of malignancy Growth rate lesion exhibits rapid growth Bleeding lesion bleeds on gentle manipulation Induration lesion and surrounding tissue is firm to the touch Fixation lesion feels attached to a
6、djacent structures Aspiration Biopsy Aspiration biopsy is the use of a needle and syringe to penertrate a lesion for aspiration of its content Indication of Aspiration Biopsy Aspiration should be carried out on all lesions thought to contain fluid or any intraosseous lesion before surgical explorati
7、on a fluctuant mass in the soft tissues should also be aspirated to determine its contents Any radiolucency in the bone of the jaw should be aspirated to rule out a vascular lesion that can cause life threatening hemorrhage Technique of Aspiration Biopsy A 18-gauge needle is connected to a 5 or 10 m
8、l syringe The tip of needle may have to be repeatedly repositioned to locate a fluid center Excisional Biopsy Removal of the entire lesion A perimeter of normal tissue surround the lesion is also excised to ensure total removal Constitute definitive treatment Indication of Excisional Biopsy Smaller
9、lesions(1 cm in diameter) Hazardous location A great suspicious of malignancy Principles of Incisional Biopsy Representative areas of lesion should be incised in wedge fasion Selected in an area that shows complete tissue changes(the lesion extends into normal tissue at the base and/or margin of the
10、 lesion) Principles of Incisional Biopsy Necrotic tissue should be avoided Taken from the edge of the lesion to include some normal tissue A deep, narrow biopsy rather than a broad,shallow one Principles of Incisional Biopsy Anesthesia Block local anesthesia techniques are employed when possible The
11、 anesthesic solution should not be injected within the tissue to be removed, because it can cause artificial distortion of the specimen Anesthesia When blocks are not possible, infilitration of local anesthesia may be used locally,but the solution should be injected at least 1 cm away from the lesio
12、n Tissue Stabilization Tongue or soft palate -Heavy retractive sutures -Towel clips Lip - assistants finger pinching the lip on both sides of the biopsy area Tissue Stabilization Identification of Surgical Margins Marked with a silk suture to orient the specimen for the pathologist If the lesion is
13、diagnosed as requiring additional treatment, the pathologist can determine which margin, if any had residual Identification of Surgical Margins One must be certain to illustrate the orientation of the lesion and the method with which the specimen was marked in the pathology data sheet Hemostasis Avo
14、id suction device Gauze wrapped over the tip of the low volume suction device Simple gauze compression Specimen Care Immediately placed in 10% formalin solution that is at least 20 times the volume of surgical specimen Totally immersed in the solution Specimen Care Care should be taken to be sure th
15、at the tissue has not become lodged on the wall of the container above the level of the formalin Surgical Closure Primary closure of the elliptic wound is usually possible Palatal biopsy: best managed postoperatively with the use of an acrylic splint Surgical Closure Dorsum or lateral border of the
16、tongue: sutures to be placed deeply and at frequent intervals into the substance of the tongue to retain closure Final Diagnosis The final diagnosis should correspond to the clinical course before and after biopsy A negative pathology report for cancer should not lull the dentist into a false sense of security when the clinical characteristics of the lesion still indicate malignant potential Final Diagnosis If the p&lt;/p&gt;</p></p>
