Oral wound healing, biopsy,exfoliative cytology

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informations collected by my colleague Dr.Kunal Banerjee

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Oral wound healing, biopsy,exfoliative cytology

  1. 1. BY:KUNAL BANERJEECRI, MADC, CHENNAI
  2. 2. CONTENTS:HEALING TYPES OF HEALING HEALING OF EXTRACTION WOUNDS AND RELATED COMPLICATIONSBIOPSY TYPES OF BIOPSY TECHNIQUES RELATED TO BIOPSYEXFOLIATIVE CYTOLOGY TECHNIQUES USES LIMITATIONS
  3. 3. HEALINGHealingReplacement of destroyed tissue by living tissue torestore function.RepairReplacement of lost tissue by granulation tissue whichresults in scarring.RegenerationReplacement of lost tissue by similar type of tissue.
  4. 4. TYPES OF HEALING:Primary IntentionThe edge of the wound in which there is no tissue loss areplaced in essentially the same anatomic position theyheld before injury.Secondary IntentionIt implies that a gap is present between the edges of anincision or that tissue loss has occurred in wound thatprevents close approximation of the wound edges.
  5. 5. HEALING OF EXTRACTION WOUNDS:It does not differ from healing in otherwounds of body except that it ismodified by the peculiar anatomicsituation which exists after removal oftooth.
  6. 6. IMMEDIATE REACTION FOLLOWINGEXTRACTION: Blood coagulation Vasodilatation Mobilization of Leucocytes Collapse of unsupported gingival tissue into position Clot contraction
  7. 7. First week wound: Periphery Center Fibroblast proliferation Blood clot Angiogenesis Layering of leucocytes Proliferating Fibroblast epithelium infiltrate & microvasculation Osteoclastic activity at crest Granulation tissue
  8. 8. Second week wound: Periphery Center PDL degenration Organisation of blood clot Frayed socket wall Outwardly extended osteoid trabeculae Epithelial proliferation
  9. 9. Third week wound Complete epithelialisation Organised clot Young trabeculae of osteoid bone at periphery Crest of alveolar bone rounded off by resorption
  10. 10. Fourth week wound: Continuous deposition remodelling and resorption of bone filling alveolar socket Radiological evidence of bone not prominent till sixth or eight week after extraction Radiological evidence of differences in new bone of alveolar socket and adjacent bone for as long as four to six months
  11. 11. COMPLICATIONS OF EXTRACTIONWOUND HEALING:A. DRY SOCKETOther names- Alveolar osteitis, localized acute alveolarosteomyelitisIncidence- more in woman and tobacco users - associated with difficult extractions Frequency- between 1 and 3.2% of all extractions
  12. 12. Factors influencing occurence of drysocket:
  13. 13. Pathogenesis: Dry socket Clot Lysis Anaerobic bacteria Plasmin
  14. 14. CLINICAL FEATURES OF DRY SOCKET:• Extreme pain• Low grade fever• Ipsilateral lymphadenopathy• Exposed bone necrosis• Foul odour• No suppuration
  15. 15. Prevention and management:•Prevention- By care excercised in handling the livingtissues• Management- Keep extraction socket clean - Irrigate with mild warm antiseptic -Then fill with obtundent dressings - Change dressings every day• Most patients symptom free after one two dressings• Other agents inserted into socket with success:Areomycin, Sulfanilimide, Sulfathiazole, Tetracyclinehydrochloride
  16. 16. B. MyospherulosisC. Fibrous healing of extractionwoundsD. Implantation cyst
  17. 17. BIOPSY•It is the removal of tissue from the livingorganism for purpose of microscopicexamination and diagnosis.• It also serves as treatment options forsmaller lesions by excising in toto.
  18. 18. TYPES OF BIOPSY:•Excisional biopsy-preferred if size of lesionis such that it may be removed along with amargin of normal tissue and the woundclosed primarily.
  19. 19. • Incisional biopsy-useful in dealing with large lesionswhich operator suspect may be treated by means otherthan surgery.• Biopsy should include surrounding normal tissue withadequate depth of underlying connective tissue.
  20. 20. METHODS USED FOR OBTAINING BIOPSY:•Surgical excision using-Scalpel•Cautery•Laser•Biopsy forceps [punch biopsy]•Aspiration with needle
  21. 21. BIOPSY TECHNIQUE:Biopsy technique Do not paint surface of area to be biopsied with iodine or highlycoloured antiseptic. If using infiltration anaesthesia inject around periphery Use sharp scalpel to avoid tearing lesions Remove border of normal tissue with specimen if at all possible Use care not to mutilate specimen Fix tissue immediately upon in 10%FORMALIN/70% alcohol If specimen is thin place it on a piece of glazed paper and drop intothe fixative to prevent curling of tissue
  22. 22. EXFOLIATIVE CYTOLOGY: This is the study of cells which exfoliated or abrade frombody surface When epithlium becomes seat of any pathology, cellslose their cohesive ness and cells in deeper layers mayshed along with superficial cells
  23. 23. SALIENT FEATURESCytology is not a substitiute but an adjunct tosurgical healing. It is a quick simple painless and bloodlessprocedure. It is especially helpful in follow up detection ofrecurrent carcinoma in previously treated cases. It is valuable for screening lesions whose grossappearance is such that biopsy is not warranted.
  24. 24. Preferred technique: Cleansing surface of oral lesion of debris and mucin Scraping of lesion several times with metal cementspatula , moistened tongue blade, cytobrush Collected material then quickly spread evenly on amicroscopic slide and fixed before specimen dries[fixative- spray cyte,95% alcohol, equal parts of alcoholand ether Allowed to stand for 30 minute to air dry Two smears are prepared for each lesion sinceadditive staining techniques are frequently employed
  25. 25. TYPES OF CYTOLOGIC SMEARS: CLASS- I CLASS CLASS V II SMEAR CLASS CLASS IV III
  26. 26. USES:•Cancer diagnosis• Herpes simplex• Herpes zoster• Pemphigus vulgaris• Benign familial pemphigus• Pernicious sickle anaemia
  27. 27. LIMITATIONS:•Presence/extent of invasion cannot be assesed• Majority of benign lesions that occur in oralcavity do not lend themselves to smear test egfibroma• Leukoplakia does not apply for smear testbecause of scarcity of viable surface cells insmears• Negatively cytology report does not rule outcancer

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