Title Excisional biopsy of tongue lesion
Description A 14 year old boy has during a coupple of months experienced soreness and swelling from the right side of the tongue. A local depression 3 mm deep is seen with no serious redness or swelling. The video shows an excisional biopsy of the lesion.
Authors Anders Nattestad og Birgit Kenrad
Length 4:15


Introduction
A 14 year old boy has during a coupple of months experienced soreness and swelling from the right side of the tongue. A local depression 3 mm deep is seen with no serious redness or swelling. Lidocaine containing adrenaline is injected as local infiltrations around and below the lesion. During the entire procedure, the tongue is fixed and extruded by means of gauze plugs. This lesion will be excised in toto, which make the procedure an excisional biopsy.

Local anaethesia
Lidocaine containing adrenaline is injected as local infiltrations around and below the lesion. During the entire procedure, the tongue is fixed and extruded by means of gauze plugs. This lesion will be excised in toto, which make the procedure an excisional biopsy.

Incision
The incision is made through the epithelium, the underlying fibrous tissue and the tongue muscle, circumscribing the lesion in a form like a ship or a spindle, attempting to let the two incisions meet below the lesion, - giving the block of excised tissue the shape of a boat’s hull below the waterline.

Excision
With the surgical pincers the tissue block is gripped in the anterior corner, not damaging the lesion in question, and preferrably keeping the grip during the whole procedure in order not to damage more tissue than nessecary. While lifting the tissue with the pincers, the block is dissected free from underlying tissue, - using the scalpel, starting from the lifted end, and cutting from one and the other side, untill the tissue is excised completely.

Histopathology
The wound is compressed by gauze, while the specimen is orientated on sterile cardboard. This specimen is placed with the epithelial surface facing the cardboard. It is important to make a note on the orientation of the specimen on the formular for the pathologist. The specimen is immidiately stored in 10 % formaline for fixation.

Suturing
The wound is sutured, - in this case using single sutures. The ends of the sutures are cut at a length not hampering the patient more than nessecary, however long enough to catch hold of at removal of the sutures 5 – 7 days postoperatively.



http://www.askdrehab.com/videos/excisional...gue-lavestL.wmv