You may or may not have heard of an oral biopsy. If you have, not only does it sound scary, but you don’t know enough about it, including when and why it is necessary. There are different types of oral biopsies that oral surgeons perform. In this article, we’ll talk about the types and purpose of an oral biopsy, as well as the actual procedure.
What is an Oral Biopsy?
Oral Biopsy is a surgical procedure to obtain tissue from the patient’s oral cavity, for microscopic examination, usually to perform a diagnosis.
Purpose of an Oral Biopsy
An Oral Biopsy can be performed for several reasons. Sometimes:
- there are inflammatory changes in the oral cavity of unknown cause that persist for long periods;
- an oral lesion interferes with proper oral function;
- for bone lesions that are not specifically identified by clinical examination and X-rays, or any oral lesion that has the characteristics of a malignancy.
Types of Oral Biopsy
There are six main types of Oral Biopsy. These are:
- Cytology: This type of Oral Biopsy can be used to diagnose lesions in the oral cavity due to post-radiation changes, herpes, and fungal infections. Cytology allows examination of individual cells but cannot necessarily result in an accurate and definitive diagnosis. It is recommended that this type of Oral Biopsy be performed along with an Excisional or Incisional Biopsy.
- Aspiration Biopsy: In this type of Oral Biopsy, the oral surgeon uses a needle and syringe to remove a sample of cells or contents of a lesion. If the oral surgeon is not able to withdraw fluid or air it probably means that the lesion is solid.
- Incisional Biopsy: This type of Oral Biopsy is performed only to sample a representative portion of the oral lesion. If the lesion is large or has many differing characteristics, it may require sampling of more than one area.
- Punch Biopsy: This is done with a punch tool for both incisional and excisional purposes. This type of Oral Biopsy is best suited for the diagnosis of oral manifestations of mucocutaneous and ulcerative conditions of the oral cavity, such as lichen planus.
- Brush Biopsy: In this type of Oral Biopsy, firm pressure with a circular brush is applied, and rotated give to ten times, causing light abrasion. The cellular material picked up by the brush is transferred to a glass slide, preserved and dried.
- Excisional Biopsy: This type of Oral Biopsy is performed for small oral lesions, usually less than 1 cm. On clinical exam, the lesion appears benign. This type of Oral Biopsy results in complete removal of the lesion.
Procedure of Oral Biopsy
Prior to performing an Oral Biopsy, the oral and maxillofacial surgeon should be fully aware of the patient’s medical status. This would involve a thorough review of the patient’s medical and dental history, including previous surgeries, medications, allergies, and any social behaviors, such as smoking, alcohol use, and illicit drug use. The oral surgeon should also perform a thorough clinical and radiographic exam.
An Oral Biopsy is usually performed under either a local anesthetic, applied locally with infiltration near the lesion, or then, regionally, with a nerve block technique. However, the anesthetic should not be applied directly into the lesion, or superficially in and around the lesion, as this may result in a false diagnosis by the oral pathologist.
Once the local anesthetic is applied, the oral surgeon should firmly retract the soft tissues surrounding the lesion, and should make an elliptical incision around the lesion, with a minimum of a 1 mm margin.
Once the lesion has been freed from the remaining soft tissues, it should be immediately placed into a sterile pathology specimen jar, containing 10% buffered formalin for fixation. The container must be labelled with accurate patient information, such as patient name, birthdate, date, and site of biopsy.
After the Oral Biopsy, firm manual pressure should be applied to the biopsy area to stem any bleeding. Finally, the incision should be closed using either resorbable or non-resorbable sutures. Sterile gauze should again be applied to the surgical site to assist with blood clotting and to prevent the swallowing of blood by the patient.
Due to the slight oozing of blood from the surgical site for about 24 hours, the patient should be provided with a packet of gauze to change every 20 to 30 minutes over the course of a day. The gauze should not be kept in the mouth overnight.
These are just some of the high-level details related to an Oral Biopsy. If you have any further questions, you can and should consult your oral surgeon. At the Harbour Pointe Oral Surgery & Advanced Dental Implant Center, we perform an oral cancer screening on every patient at every exam. We realize that studies show that 1 in 80 persons can develop the early signs of oral cancer throughout their lifetime.
We treat each patient individually and patiently answer any and all questions they may have related to their oral health, including oral biopsy procedures if appropriate. So, the next time you think you need an oral screening, do not hesitate to visit us at Harbour Pointe Oral Surgery and Advanced Dental Implant Center for an early and accurate diagnosis!
For more information about an Oral Biopsy, Oral Surgery or Dental Implants, consult Dr. Brian Hart and
Dr. Kathleen Isdith at 425-353-1009 or at hporalsurgery@gmail.com or go to our website www.harbourpointeoralsurgery.net for more information.