oral wound healing, biopsy,exfoliative cytology
DESCRIPTION
informations collected by my colleague Dr.Kunal BanerjeeTRANSCRIPT
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BY:
KUNAL BANERJEE
CRI, MADC, CHENNAI
ORAL WOUND HEALING, BIOPSY,EXFOLIATIVE CYTOLOGY
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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:
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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
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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:
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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:
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Blood coagulation
Vasodilatation
Mobilization of Leucocytes
Collapse of unsupported gingival tissue into position
Clot contraction
IMMEDIATE REACTION FOLLOWING EXTRACTION:
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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:
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Periphery
PDL degenration
Frayed socket wall
Outwardly extended osteoid
trabeculae
Epithelial proliferation
Center
Organisation of
blood clot
Second week wound:
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Complete epithelialisation
Organised clot
Young trabeculae of osteoid bone at periphery
Crest of alveolar bone rounded off by resorption
Third week wound
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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:
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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:
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Factors influencing occurence of dry socket:
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Clot Lysis
Dry socket
Plasmin
Anaerobic bacteria
Pathogenesis:
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• Extreme pain
• Low grade fever
• Ipsilateral lymphadenopathy
• Exposed bone necrosis
• Foul odour
• No suppuration
CLINICAL FEATURES OF DRY SOCKET:
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•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:
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B. Myospherulosis
C. Fibrous healing of extraction wounds
D. Implantation cyst
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• 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
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• 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:
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• 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.
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METHODS USED FOR OBTAINING BIOPSY:
•Surgical excision using-Scalpel
•Cautery
•Laser
•Biopsy forceps [punch biopsy]
•Aspiration with needle
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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:
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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:
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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
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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
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SMEAR
CLASS-I
CLASS II
CLASS IIICLASS IV
CLASS V
TYPES OF CYTOLOGIC SMEARS:
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•Cancer diagnosis
• Herpes simplex
• Herpes zoster
• Pemphigus vulgaris
• Benign familial pemphigus
• Pernicious sickle anaemia
USES:
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•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: