The most common type of biopsy used in oral cavity is.. Excisional biopsy

The most common type of biopsy used in oral cavity is:

a- Excisional biopsy. *** 

b- Incisional biopsy. 

c- Aspiration through needle. 

d- Punch biopsy.
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The biopsy is a complementary examination of a paramount diagnostic value, allowing to confirm or refute the diagnosis made during the clinical examination. It is a surgical procedure that requires a rigorous technique on the part of the operator.

Our work therefore proposes to describe, in a detailed way, the indications and contraindications of this surgical procedure, as well as the operating protocol of the most frequently performed biopsies in current practice, namely, the incisional biopsy, excisional biopsy and gland biopsy. salivary accessories.

The polymorphism of the oral mucosal affections raises the problem of diagnosis.
In fact, besides the clinical diagnosis oriented by physical as well as functional signs, the diagnosis of certainty can only be made thanks to an anatomo-pathological examination.

Thus, in his current practice, the clinician may have to perform several types of samples at the level of the oral mucosa:
- Incisional biopsy, - Excisional biopsy, - Extemporaneous biopsy, - Smear,
- Needle biopsy.

The practitioner may also be required to take samples from other tissues. Among others, he may need to perform bone biopsies, ganglionnaires, salivary ...
The present article proposes to develop the indications and contraindications of the incisional biopsy, excisional and those of accessory salivary glands, as well as the operative technique of this surgical act.

DEFINITION OF BIOPSY:

Biopsy consists of taking a fragment of living tissue by surgical means for the purpose of histological, biochemical, microbiological or immunological examination.

INDICATIONS OF BIOPSY:

The most common indication of a biopsy is the establishment or confirmation of the diagnosis of a suspicious lesion. The latter is characterized by the following elements:

• No cure within a reasonable amount of time (2 weeks),

• Symptomatology and clinical appearance that does not allow the diagnosis to be made or to determine whether it is a benign or malignant lesion.

Recall that the signs of malignancy are represented by the budding or ulcerous appearance, induration, adherence to deep planes, the absence of pain, the presence of lymphadenopathy and the existence of isolated dental mobility without cause related. When the diagnosis of a suspicious lesion is already clinically carried out, the biopsy makes it possible to confirm and specify its nature and its own characteristics.

It is the same for the beginning malignant lesions, which, most often, can be suspected of malignancy without being firmly diagnosed as such on the only clinical examination, which explains the necessity of a histological confirmation which alone authorizes the starting a treatment. Indeed, the signs of call are often late and appear only at a fairly advanced stage of the pathology (pain, dysphagia, earache ...).

Thus, in front of a malignant lesion, the interest of the biopsy is then threefold. In addition to the histological classification of the tumor, it can make it possible to know its evolution and to modulate the therapy accordingly. Depending on the histological nature, it is possible to appreciate radio or tumor chemosensitivity. The treatment will be definitively codified, even corrected as soon as the result of the sampling.

In other situations, however, the clinic alone does not make it possible to make an accurate diagnosis, it is then the anatomo-pathological examination that it is incumbent to make this diagnosis.

For example, chronic nonspecific ulceration or erythema multiforme may suggest several probable diagnoses that are virtually indistinguishable from clinical examination alone.

• - The biopsy also makes it possible to pose the diagnosis of infectious pathologies: Tuberculosis, Syphilis, Herpes.

• The biopsy is indicated also in the pathologies related to dermatoses: Lichen plan, pemphigus ...

• It can be vesicular, bullous or other diseases. In this case the biopsy should be done on a young element, if possible, a vesicle or an intact bubble.

• When the roof of the bubble is absent the sample should include the lesion and the adjacent mucosal area.

• In the pathology of accessory salivary glands, the biopsy is of considerable contribution not only for the pathologies specific to the accessory salivary glands like the salivary lithiases, but also for the etiological diagnosis of a dry syndrome, which may or may not fall under certain conditions. systemic pathologies such as sarcocoedosis, Gougerot syndrome...

• The biopsy can finally be indicated in case of carcinophobia. Indeed, certain physiological anatomical variations (geographical language, ethnic gingival coloration ...) can worry carcinophobic patients. Performing a biopsy and presenting the pathologist's report to the patient is often a very effective therapeutic method.