Skill Checkup: Excision of Mouth Lesions

Arlen D. Meyers, MD, MBA

Disclosures

May 09, 2019

A wide range of disorders can lead to mucosal changes in the oral cavity. Most oral lesions are adequately diagnosed on the basis of a detailed history and thorough physical examination alone, and can be treated accordingly. The appearance of any lesions should be documented in detail (dimension, location, color) and followed closely over days or weeks. However, lesions that persist despite adequate treatment or raise concerns for neoplasm should promptly undergo either punch, incisional, or excisional biopsy.

A more thorough review of mouth lesion excision is also available.

Procedure

One percent lidocaine (Xylocaine) with 1:100,000 epinephrine is injected submucosally into the area surrounding the lesion. Approximately 10 minutes should elapse to allow the epinephrine-induced vasoconstriction to reach maximal effect. For an incisional biopsy, a #15 scalpel is used to take a sample of the tissue. For an excisional biopsy, incise the mucosa in an ellipse around the lesion, with a small cuff of normal mucosa included. The lesion is grasped with the forceps and retracted gently so that deeper dissection may be done with the electrocautery or sharp dissection. A wedge of the underlying tissue is removed with the lesion. The depth of excision depends on the depth of the lesion. For most lesions of the oral mucosa, a very superficial dissection is all that is required. For deeper lesions, margins can be obtained to determine whether more extensive surgery is required. Intraoperative consultation with a pathologist can provide insight into a preliminary tissue diagnosis.

A combination of direct pressure and electrocautery is used to obtain hemostasis. Once adequate hemostasis is obtained, the wound is closed with an absorbable suture. Closure of small, superficial defects may be performed with one layer of simple, interrupted 4-0 (chromic gut or Vicryl) sutures. Defects in the tongue may require one or two deeper and buried sutures to close the muscle and eliminate any dead space. A 3-0 suture should be used for closure of tongue defects.

A video depicting oral mass excision can be seen below.

 

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