Oral Biopsies - Operative Warnings
This list of warnings might seem excessive to some
however the legal ruling in the case of
Chester vs Afshar
would suggest that it is quite prudent / necessary
to list them.  Others might say that there isn't enough
information but where do you stop?

The following list of warnings regarding
oral biopsies is
neither exhaustive nor is it predictive.  The most pertinent
warnings have been included here.

Pain.  As it is a surgical procedure, there will be soreness
after the biopsy.  This can last for several days.

Painkillers such as
ibuprofen, paracetamol, Solpadeine or
Nurofen Plus are very effective.  Obviously, the analgesic
you use is dependent on your medical history & the pain
you are experiencing.

Swelling.  There will be swelling afterwards.  This can last
several days.

Use of an ice-pack or a bag of frozen peas pressed
against the cheek adjacent to the biopsy site, will help to
decrease the swelling.

Avoidance in the first few hours post-op, of alcohol,
exercise or hot foods / drinks will decrease the degree of
swelling that will develop.

Occasionally, there is bleeding into the cheek or the floor
of the mouth (dependent on where the biopsy took place)
- there may well be limitations to mouth opening or tongue
use respectively.  This also improves with time.

Stitches.  The biopsy will often be closed with stitches.  
These are dissolvable and ‘fall out’ within 10 – 14 days.

Limited Mouth Opening (Trismus).  Often the chewing
muscles and the jaw joints are sore after the procedure so
that mouth opening can be limited for the next few days.

Scarring / Lumpiness at the Biopsy Site.  Any cut to soft
tissues produces a scar.  Initially, after a biopsy, a scar
will be produced.  This softens and disappears (i.e.
improves) with time.

Regardless, it can feel quite obvious and lumpy
(especially if the biopsy has been in the lips or cheeks.

The scarring can also dependent on the size and size of
the biopsy and the individuals’ tendency to scarring.

Initial Tautness / Tenderness at the Biopsy Site.  The
biopsy margins are brought together with stitches hence
there is some tension at the operation site.  This tails off
as the swelling goes down.

Localised Area of Numbness at the Biopsy Site.  This
especially effects the lips and tongue (tip).  Biopsies can
damage the local nerves resulting in areas of numbness.  
These can take a number of months before normal feeling
Last Updated 23rd November 2014
Recurrence.  Dependent on what is biopsied, there is a chance that the lesion can
recur.  They recur either due to the nature of the lump / patch or due to the
recurrence of conditions that caused the lump / patch to develop.

For instance, during pregnancy many odd
lumps and bumps develop on the gums.  
If they are removed / biopsied, they recur.  They are often left until after the end
of pregnancy as most of the lesions disappear or dramatically regress.

Polyps on the cheeks or lips can recur as the patient may bite on these areas
again producing the
polyps anew.

Inconclusive Results & the Need for Re-Biopsy.  The biopsy results can come back
as inconclusive.

If this is the case, then it is possible that the lesion may need to be biopsied again.

If all the lump / bump has been removed, it is very unlikely that these come back as
inconclusive (and also there is no possibility of re-biopsying the site).

Further Treatment Dependent on Results.  Depending on what the biopsy results
are, will determine whether further treatment is required.

If the lump turns out to be just a
polyp or granuloma, then nothing further needs to
be done.

If the patch turns out to be symptomatic
lichen planus then steroids can be
prescribed and the patch can be reviewed in initially by the hospital and then by the
GDP / GMP.  If the lump turns out to be more serious, then further investigations
and treatments may be necessitated.

Anatomical-Specific Warnings:

Tongue – limitation mobility / function of tongue (due to swelling, tenderness etc);
marked swelling.

Gumsgum recession, hot-cold sensitivity due to exposed dentine as the gum
recedes; need for use of
Coe-Pak (surgical dressing / cement) dressing.

Cheeks – numbness / tingling at the biopsy site (especially if biopsy of lip);
problems with salivary gland ducts (adjacent to the upper 1st molars) being
traumatised, tied off (by stitches) or cut through.

Floor of Mouth - altered sensation; problems with salivary gland ducts being
traumatised, tied off (by stitches) or cut through.

Roof of Mouth – bleeding from biopsy site due to difficulty in apposing the wound
roof of mouth-floor of nose communications (especially if the soft palate is
being operated on); need for use of