Plate 07 · Procedures
Oral pathology & biopsy
Any mucosal lesion that has not resolved two weeks after removing an obvious cause needs a diagnosis, not another review. We keep assessment slots open every week for exactly this, and we will not ask a suspicious lesion to wait for a routine appointment.
For the referring practice
Assessment and biopsy of mucosal and intra-osseous lesions, with a same-week pathway for anything suspicious and direct referral into head-and-neck oncology where required.
In plain language
Getting a definite answer about a lump, patch or ulcer in the mouth by taking a small sample and having a pathologist look at it.
Both are always on this page. The switch in the header decides the order everything else is presented in, not whether you are allowed to read it.
01
When we would operate
And, just as importantly, when we would not. A referral that ends in a recommendation to do nothing is a good outcome, not a wasted appointment.
- Any ulcer or mucosal change persisting beyond two weeks with no obvious resolving cause
- Non-homogeneous or speckled leukoplakia; any erythroplakia
- Induration, fixation, or a rolled everted margin
- Unexplained tooth mobility without periodontal explanation
- Altered sensation of the lip or chin without a dental cause — the numb chin sign
- A radiolucency or radiopacity of unknown cause
- A neck node without an infective explanation
- Any lesion the patient or referrer is worried about, whatever it looks like
02
How it is done
Incisional biopsy
For larger or diffuse lesions, and for anything where the diagnosis will change the operation. Taken from the most representative area including a margin of adjacent normal tissue, avoiding necrotic centre.
Excisional biopsy
For small, clinically benign, well-defined lesions where complete removal is both diagnostic and definitive.
Handling
Orientation suture where margin reporting matters, immediate fixation in ten per cent neutral buffered formalin at ten times specimen volume, and a request form with a clinical description, a differential and a diagram. A pathologist reporting an unlabelled pot with "lesion" written on the form is being asked to work blind.
Intra-osseous lesions
Aspiration before opening any radiolucency. Fluid, blood, air or nothing each change the plan, and aspirating a vascular lesion you thought was a cyst is a bad afternoon.
After the result
We contact the patient with the result personally, and we copy you the same day. Anything malignant or in doubt goes straight to the head-and-neck multidisciplinary team rather than back into a routine list.
- Clinical photographs with a scale, if you have them.
- A periapical or panoramic for anything with a bony component; CBCT for cortical expansion or perforation.
- Please record the size in millimetres and the exact site, not "left cheek".
- A note of tobacco, alcohol, betel and areca use, and of any immunosuppression.
A note back to you
Do not sit on it. If a lesion has persisted two weeks past removing the cause, refer. We keep weekly assessment slots for suspicious lesions and you can call the direct line to have one used the same week. If you biopsy in practice and the report is unexpected, send us the report and the blocks reference — we will take it from there.
04 · Consent
Risks, stated rather than softened.
Every figure below is a published-literature range and is labelled as one. None of them is a claim about this practice's results, and there are no success rates anywhere on this site. You should hear all of this out loud before you consent to anything, not only read it.
Bleeding
Usually trivial and controlled with a suture. Tongue and floor-of-mouth sites bleed more freely.
Altered sensation
Biopsy near the mental nerve, the lingual nerve or the greater palatine bundle can leave a numb patch. Site-specific and discussed before the biopsy.
Non-diagnostic sample
Occasionally the sample does not contain enough representative tissue and the biopsy has to be repeated. It is better to repeat it than to act on an inadequate specimen.
Infection
Uncommon in the mouth. Antibiotics are not routine.
A benign-looking lesion turning out not to be benign
This is the reason the biopsy exists. We do not diagnose from a photograph and we would rather biopsy ten harmless lesions than watch one that was not.
05
What the timeline looks like
Recovery varies between people. The general recovery instructions — bleeding, swelling, diet, medication timing and dry socket — are on the after-your-surgery page.
06 · For patients
The questions people actually ask us in the chair.
What actually happens?
The area is numbed with an injection. A small piece of tissue — often only a few millimetres — is removed and a stitch or two is placed. The whole appointment is usually under half an hour. It is sore for a couple of days, like a mouth ulcer.
When will I know?
Most results come back within five to ten days. We will telephone you with the result, whatever it is. We do not leave people waiting for a letter.
Should I be frightened?
Most mouth lesions we biopsy are not cancer. We biopsy them precisely so that nobody has to guess. If it does turn out to be something serious, finding it now is the best possible version of that news.
07
More on this procedure
Next
Send us this case with the imaging listed above, or call the referral line on (612) 555-0150 if it needs to be seen sooner than a form allows.
If your dentist has already referred you, we will contact you to book. If you would like a second opinion, you can come to us directly.