Patient perception after oral biopsies: an observational out-patient study
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1
Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Head and Neck Department, Italy
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2
University of Foggia, Department of Clinical and Experimental Medicine, Italy
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3
University of Eastern Finland, Department of Oral and Maxillofacial Diseases, Finland
Aim. Oral biopsy is a frequent and low risk surgical diagnostic procedure and nowadays it is the gold standard in the diagnosis of oral diseases. Most studies evaluated the specificity and sensibility of this diagnostic tool, whereas few studies evaluated the psychological aspects related to the wound healing after oral biopsy procedure. The aim of this observational study was to describe the patient perception related to wound healing after oral biopsies, either in incisional or excisional biopsies, and determine risk factors for a painful healing.
Materials and Methods. Eighty patients underwent oral biopsies for diagnostic or therapeutic purpose (Oral Medicine, Head and Neck Department, “Fondazione Policlinico Universitario A. Gemelli – IRCCS”), between January 2017 and February 2018. Mean age of patients was 60,25 (range: 23-88), 50 were female and 30 male. Type of biopsy (incisional or excisional), location, blade type (conventional or laser), suture type (diameter and material), postoperative bleeding, wound healing clinical appearance (poor, satisfactory, good) and other intra or post-surgical complications were recorded. Photos of samples were taken in a standard photographic setting, in order to calculate the harvested volume through an image software (ImageJ, NIH, Bethesda, Maryland, USA). To evaluate the psychological and behavioral impact of the post-operative discomfort, two survey tools were administered: Oral Health Impact Profile-14 (OHIP-14) and visual number scale of pain (VNS) were administered at 6 hours, 7 days and 21 days after biopsy. A post-operative VNS major than 4/10 and an OHIP-14 major than 20/70 were considered representative of a painful healing. Sample size was calculated according to simple random sampling formula in 80 cases. Risk factors for a painful healing were calculated through a stepwise logistic regression. Statistic was performed using the software SPSS 23 (IBM, Armonk, New York, USA). The research was approved by the Ethical Committee of the Catholic University (Ref. 48108/17).
Results. Forty-eight biopsies were incisional and 32 were excisional, 28 were in OLP patients, 13 for fibromas, 14 for leukoplakia and 25 for other lesions. Twenty-seven were made in cheeks, 9 in gingival mucosa, 8 in the dorsal tongue and 36 in other sits. Eight patients had during the following 6 hours post-operative easily controlled bleeding, and 7 needed pain killer therapy; no patients presented severe intra-operative or post-operative complications. The mean sample volume was 231.41 mm3 (15-1250 mm3). Six hours after the biopsy 72.5% of cases reported a OHIP lower than 20/70 and 70% a VNS lower than 4/10. One week after the biopsy 92.5% of cases reported a OHIP lower than 20/70 and 90% a VNS lower than 4/10. Three weeks after the biopsy 98.75% of cases reported a OHIP lower than 20/70 and 97.5% a VNS lower than 4/10. At the univariate analysis, “type of lesion” (p=0.04), post-operative complications (p=0.001), bad wound healing (p=0.004) had a statistical significant correlation with an high OHIP six hours after the biopsy; a bad wound healing (p=0.01) had a statistical significant correlation with an high OHIP seven days after the biopsy; “type of lesion” (p=0.04) had a statistical significant correlation with an high OHIP 21 days after the biopsy; drugs had a statistical significant correlation with VNS six hours after biopsy; a bad wound healing, site of biopsy and diameter of suture had a statistical significant correlation with VNS one week after biopsy (p=0.001); “type of lesion” (p=0.04) had a statistical significant correlation with an high VNS 21 days after the biopsy. In a stepwise logistic multiple regression, only post-operative complications were significant correlated with an high OHIP 6 hour after the biopsy (p<0.05) and a bad wound healing with the VNS one week after biopsy (p<0.05).
Discussion. Within the limitations of this study, results confirm that oral biopsy is a safe surgical procedure, with a low risk of complications and a good tolerability; the study shows that the patient perception and the wound healing after biopsies are influenced most of all by the type of lesion. Oral chronic diseases don’t have a good response to the surgery, specially in incisional biopsies where is uneasy to ottempt a primary closure of the wound. Further studies are required to better understand the other variables that may influence the post-operative discomfort.
References
1. Biopsy and istopathologic diagnosis of oral premalignant and malignant lesions. Poh CF, Ng S, Berean KW, Williams PM, Rosin MP, Zhang L. 283-8, s.l. : J Can Dent Assoc , 2008.
2. Autohelp the oral pathologist in making an accurate diagnosis. Masthan KM, Sankari SI, Babu NA, Rejguru JP. 181-4, s.l. : J Clin Diagn Res, 2013.
3. The use of biopsy in dental practice: the position of the American Academy of Oral and Maxillofacial Pathology. Melrose RJ, Handlers JP, Kerpel S.,Summerlin D-J, Tomick JC. 457-461, s.l. : Jen Dent, 2007.
Keywords:
wound,
healing,
Biopsy,
Patient perception,
OHIP-14
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Rizzo
I,
Vanella
I,
Giuliani
M,
Patini
R,
Siponen
M and
Lajolo
C
(2019). Patient perception after oral biopsies: an observational out-patient study.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00082
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Received:
05 Nov 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Irene Rizzo, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Head and Neck Department, Rome, Lazio, 00168, Italy, irenerizzo@14gmail.com