Mandibular Bone Biopsy – 4 Important Indications, care instructions

What is Mandibular Bone Biopsy

Mandibular bone biopsy is a procedure to remove a small piece of your lower jawbone (mandible) so the bone cells can be examined under a microscope.

Why is this procedure done?

You may need the Mandibular Bone Biopsy procedure if you have an abnormal growth (lesion) in your mandible.

Growths in the mandible can be fluid-filled sacs (cysts) or solid masses (tumors).

A bone biopsy helps your health care provider make a diagnosis and plan the right treatment for you.

What happens after the procedure?

  • You may have to keep a gauze pad in your mouth until bleeding stops.
  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • Do not drive for 24 hours if you were given a sedative.

What happens during the Mandibular Bone Biopsy procedure?

  • An imaging test may be done to confirm the location of the growth and to guide the biopsy.
  • To reduce your risk of infection, your health care team will wash or sanitize their hands.
  • An IV may be inserted into one of your veins.
  • You will be given one or both of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
  • A device may be placed in your mouth to keep it open and to hold your tongue out of the way.
  • A small incision will be made inside your mouth through the lining over your mandible (mucosa).
  • A hollow needle will be inserted through the incision and into the bone above the lesion.
  • Another needle may be inserted through the hollow needle to remove a biopsy sample.
  • The needles will be removed.
  • A gauze pad will be held over the incision to control bleeding.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the indications?

Here are the indications of the Mandibular Bone Biopsy

  1. Suspected jaw bone infection: If there is a suspicion of an underlying jaw bone infection, such as osteomyelitis, a bone biopsy may be performed to confirm the diagnosis. This allows for identification of the specific infectious agent and determination of the appropriate treatment.
  2. Evaluation of jaw bone lesions or tumors: When there are abnormal growths, cysts, or tumors in the mandible, a bone biopsy can help establish a definitive diagnosis. The biopsy sample is examined under a microscope to identify the nature of the lesion, whether it is benign or malignant, and to guide further treatment planning.
  3. Assessment of bone diseases: In certain cases of bone diseases affecting the mandible, such as osteoporosis, osteopenia, or Paget’s disease, a bone biopsy may be performed to evaluate the extent of bone involvement and assess the underlying pathology.
  4. Jaw bone grafting: Prior to jaw bone grafting procedures, such as dental implant placement or reconstructive surgeries, a bone biopsy may be conducted to assess the quality and suitability of the existing bone for grafting purposes.
  5. Evaluation of unexplained jaw pain or pathology: If there is unexplained jaw pain, bone loss, or abnormal radiographic findings in the mandible, a bone biopsy may be performed to investigate the cause and guide appropriate management.
  1. Any radiolucent bone lesion (usually periapical lucency) that fails to respond to root canal treatment
  2. Any intraosseous lesion that appears unrelated to the tooth
  3. Inflammatory changes of unknown cause that persists for long periods
  4. Radiolucent or radio-opaque osseous lesions that are expanding in size, displacing normal anatomy (expanding the bone or displacing or eroding the teeth)

What happens before the procedure?

  • Follow instructions from your health care provider about eating and drinking restrictions before the Mandibular Bone Biopsy procedure.
  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

The Mandibular Bone Biopsy procedure may vary among health care providers and hospitals.

Suspicious radiological findings in the jaw bone require histopathological examination for the confirmation of a diagnosis.

As pathologies in this region are difficult to reach or are in close proximity to relevant anatomical structures, e.g. tooth roots or nerves, they often represent a challenge. Such factors may adversely affect the predictability of the surgical outcome of a biopsy of the osseous tissues.

This technical note introduces a novel method for performing a digitally planned, guided biopsy.

For this purpose, a cone beam computed tomography scan and an intraoral scan are superimposed using specific planning software.

The resulting three-dimensionally printed, tooth-supported drilling template is designed for a trephine biopsy.

It allows a precise, minimally invasive approach, with an exact three-dimensional determination of the biopsy location prior to surgery.

The risk of devitalization of the neighbouring teeth or possible damage to the nerve structures can be minimized. Furthermore, a small access flap can be sufficient.

In summary, the method of bone biopsy presented here allows high precision and greater predictability for biopsy sampling and is minimally invasive for the patient.

What are the risks of Mandibular Bone Biopsy?

Generally, Mandibular Bone Biopsy is a safe procedure. However, problems may occur, including:

  • Damage to the mandible.
  • Damage to the nerves, blood vessels, or other structures around the mandible.
  • Bleeding.
  • Infection.
  • Allergic reactions to medicines or dyes.

Care After Mandibular Bone Biopsy

Here is the information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the Mandibular Bone Biopsy procedure?

After the Mandibular Bone Biopsy, it is common to have:

  • Numbness in your jaw. This will go away when the numbing medicine wears off.
  • Soreness.
  • Swelling.
  • Blood-tinged mucus when you cough (sputum).

Follow these instructions at home:

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Change the gauze packing in your mouth as told by your health care provider.
    • Wash your hands with soap and water before you change the gauze. If soap and water are not available, use hand sanitizer.
  • Rinse your mouth with a cool salt-water mixture 3–4 times per day or as needed. To make a salt-water mixture, completely dissolve ½–1 tsp of salt in 1 cup of cool water.
  • Check your biopsy site every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • Keep your head above the level of your heart while you are lying down.
  • If directed, apply ice to your jaw area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times per day.

Driving

  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not drive for 24 hours if you were given a medicine to help you relax (sedative).

Eating and drinking

  • Follow instructions from your health care provider about other eating or drinking restrictions. Do not eat hot foods or drink hot liquids until your health care provider says you can return to your normal diet.
  • Do not eat foods that you have to chew until your mouth is no longer numb.
  • Avoid foods that are hard, dry, sticky, chunky, lumpy, or stringy. Also avoid foods with nuts, seeds, raisins, skins, or pulp.
  • Avoid liquids that have seeds, pulp, or chunks.

General instructions

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have chills or a fever.
  • You have signs of infection in the area of your biopsy. Signs of infection include:
    • More redness, swelling, or pain.
    • Pus or a bad smell.
  • Your biopsy site is bleeding.
  • You have pain that is not controlled by your pain medicine.

Get help right away if:

  • You have severe pain or swelling in your jaw area or inside your mouth.
  • You have fresh bleeding that does not stop after you apply pressure with a gauze pad.
  • After the Mandibular Bone Biopsy procedure, you may have numbness in your jaw. This will go away when the numbing medicine wears off.
  • Follow instructions from your health care provider about how to take care of your incision.
  • Check your biopsy site every day for signs of infection.
  • Icing your jaw and keeping your head above the level of your heart when you are lying down will help to manage the pain and swelling.

What are the Complications of Mandibular Bone Biopsy

While it is generally considered a safe procedure, there are potential complications that can occur.

Some of the possible complications of mandibular bone biopsy include:

  1. Bleeding: Bleeding is a common complication of any surgical procedure, including a bone biopsy. It is usually minor and can be controlled with pressure or local measures. In rare cases, significant bleeding may require additional intervention or transfusion.
  2. Infection: There is a risk of infection at the biopsy site. Proper sterile technique and post-procedure care can minimize this risk, but it is not completely eliminated. Signs of infection include redness, swelling, warmth, pain, and drainage from the biopsy site.
  3. Nerve Injury: The mandible contains various nerves, including the inferior alveolar nerve, which provides sensation to the lower lip and chin. Injury to these nerves during the biopsy procedure can result in altered sensation, numbness, or tingling in the affected area.
  4. Fracture: Although rare, there is a risk of fracturing the mandible during the biopsy procedure, particularly if the bone is already weakened or if excessive force is applied. This risk is higher in individuals with underlying bone diseases, such as osteoporosis or osteomyelitis.
  5. Damage to Adjacent Structures: The proximity of the mandible to important structures, such as teeth, blood vessels, and salivary glands, poses a risk of damage during the biopsy procedure. Careful planning and execution of the biopsy can help minimize this risk.
  6. Pain and Discomfort: After the biopsy, it is common to experience pain, swelling, and discomfort at the biopsy site. These symptoms are usually temporary and can be managed with pain medications and appropriate post-procedure care.
  7. Bruising and discomfort
  8. Bone fracture
  9. Bone infection (osteomyelitis)
  10. Damage to surrounding tissue
  11. Excessive bleeding
  12. Infection near the biopsy areas

It’s important to discuss the potential risks and complications of a mandibular bone biopsy with the healthcare professional performing the procedure. They will provide specific information based on the individual patient’s condition, medical history, and the purpose of the biopsy. Taking proper precautions, following post-procedure instructions, and promptly reporting any concerning symptoms can help reduce the risk of complications and ensure appropriate management if they occur.

Summary

  • A mandibular bone biopsy is a procedure to remove a small piece of your jawbone (mandible) so the bone cells can be examined under a microscope.
  • A bone biopsy helps your health care provider make a diagnosis and plan the right treatment for you.
  • Before your Mandibular Bone Biopsy procedure, make plans to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
  • After the procedure, you may have to keep a gauze pad in your mouth until bleeding stops.
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