Oral wound healing, biopsy,exfoliative cytology

BY:

KUNAL BANERJEE

CRI, MADC, CHENNAI

ORAL WOUND HEALING, BIOPSY,EXFOLIATIVE CYTOLOGY

HEALING

TYPES OF HEALING

HEALING OF EXTRACTION WOUNDS AND RELATED COMPLICATIONS

BIOPSY

TYPES OF BIOPSY

TECHNIQUES RELATED TO BIOPSY

EXFOLIATIVE CYTOLOGY

TECHNIQUES

USES

LIMITATIONS

CONTENTS:

Healing

Replacement of destroyed tissue by living tissue to restore function.

Repair

Replacement of lost tissue by granulation tissue which results in scarring.

Regeneration

Replacement of lost tissue by similar type of tissue.

HEALING

Primary Intention

The edge of the wound in which there is no tissue loss are placed in essentially the same anatomic position they held before injury.

Secondary Intention

It implies that a gap is present between the edges of an incision or that tissue loss has occurred in wound that prevents close approximation of the wound edges.

TYPES OF HEALING:

It does not differ from healing in other wounds of body except that it is modified by the peculiar anatomic situation which exists after removal of tooth.

HEALING OF EXTRACTION WOUNDS:

Blood coagulation

Vasodilatation

Mobilization of Leucocytes

Collapse of unsupported gingival tissue into position

Clot contraction

IMMEDIATE REACTION FOLLOWING EXTRACTION:

Periphery

Fibroblast proliferatio

n

Angiogenesis

Proliferating epithelium

Osteoclastic activity at

crest

Center

Blood clot

Layering of

leucocytes

Fibroblast infiltrate &

microvasculation

Granulation tissue

First week wound:

Periphery

PDL degenration

Frayed socket wall

Outwardly extended osteoid

trabeculae

Epithelial proliferation

Center

Organisation of

blood clot

Second week wound:

Complete epithelialisation

Organised clot

Young trabeculae of osteoid bone at periphery

Crest of alveolar bone rounded off by resorption

Third 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

Fourth week wound:

A. DRY SOCKET Other names- Alveolar osteitis, localized acute alveolar osteomyelitis

Incidence- more in woman and tobacco users

- associated with difficult extractions

Frequency- between 1 and 3.2% of all extractions

COMPLICATIONS OF EXTRACTION WOUND HEALING:

Factors influencing occurence of dry socket:

Clot Lysis

Dry socket

Plasmin

Anaerobic bacteria

Pathogenesis:

• Extreme pain

• Low grade fever

• Ipsilateral lymphadenopathy

• Exposed bone necrosis

• Foul odour

• No suppuration

CLINICAL FEATURES OF DRY SOCKET:

•Prevention- By care excercised in handling the living tissues

• 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, Tetracycline hydrochloride

Prevention and management:

B. Myospherulosis

C. Fibrous healing of extraction wounds

D. Implantation cyst

• It is the removal of tissue from the living organism for purpose of microscopic examination and diagnosis.

• It also serves as treatment options for smaller lesions by excising in toto.

BIOPSY

• Excisional biopsy-preferred if size of lesion is such that it may be removed along with a margin of normal tissue and the wound closed primarily.

TYPES OF BIOPSY:

• Incisional biopsy-useful in dealing with large lesions which operator suspect may be treated by means other than surgery.

• Biopsy should include surrounding normal tissue with adequate depth of underlying connective tissue.

METHODS USED FOR OBTAINING BIOPSY:

•Surgical excision using-Scalpel

•Cautery

•Laser

•Biopsy forceps [punch biopsy]

•Aspiration with needle

Biopsy technique

Do not paint surface of area to be biopsied with iodine or highly coloured 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 into the fixative to prevent curling of tissue

BIOPSY TECHNIQUE:

This is the study of cells which exfoliated or abrade from body surface

When epithlium becomes seat of any pathology, cells lose their cohesive ness and cells in deeper layers may shed along with superficial cells

EXFOLIATIVE CYTOLOGY:

Cytology is not a substitiute but an adjunct to surgical healing.

It is a quick simple painless and bloodless procedure.

It is especially helpful in follow up detection of recurrent carcinoma in previously treated cases.

It is valuable for screening lesions whose gross appearance is such that biopsy is not warranted.

SALIENT FEATURES

Preferred technique: Cleansing surface of oral lesion of debris and mucin

Scraping of lesion several times with metal cement spatula , moistened tongue blade, cytobrush

Collected material then quickly spread evenly on a microscopic slide and fixed before specimen dries[ fixative- spray cyte,95% alcohol, equal parts of alcohol and ether

Allowed to stand for 30 minute to air dry

Two smears are prepared for each lesion since additive staining techniques are frequently employed

SMEAR

CLASS-I

CLASS II

CLASS IIICLASS IV

CLASS V

TYPES OF CYTOLOGIC SMEARS:

•Cancer diagnosis

• Herpes simplex

• Herpes zoster

• Pemphigus vulgaris

• Benign familial pemphigus

• Pernicious sickle anaemia

USES:

•Presence/extent of invasion cannot be assesed

• Majority of benign lesions that occur in oral cavity do not lend themselves to smear test eg fibroma

• Leukoplakia does not apply for smear test because of scarcity of viable surface cells in smears

• Negatively cytology report does not rule out cancer

LIMITATIONS: