What is Oral and maxillofacial pathology?

The diseases of the mouth ("oral cavity" or "stoma"), jaws ("maxillae" or "Gnath"), and related structures such as salivary glands, temporomandibular joints, facial muscles, and perioral skin are referred to as oral and maxillofacial pathology (the skin around the mouth). The mouth is a vital organ with numerous functions. It is also prone to a number of medical and dental conditions.

The specialty of oral and maxillofacial pathology is concerned with the diagnosis and study of diseases that affect the oral and maxillofacial region. It is sometimes considered a branch of dentistry or pathology. The term head and neck pathology is sometimes used instead, which may indicate that the pathologist also treats (ear, nose, and throat) disorders in addition to maxillofacial disorders. There is some overlap in this role between the expertise of head and neck pathologists and that of endocrine pathologists.

Diagnosis:

A thorough medical, dental, social, and psychological history, as well as an assessment of certain lifestyle risk factors that may be involved in disease processes, are essential components of any diagnosis. This is followed by a comprehensive clinical examination of extra-oral and intra-oral hard and soft tissues.

Although a diagnosis and treatment plan can sometimes be determined based on history and examination, it is best practise to compile a list of differential diagnoses. Differential diagnosis enables decisions on what additional investigations are required in each case.

Screening tests, imaging (radiographs, CBCT, CT, MRI, ultrasound), and histopathology are all used in the diagnosis of oral and maxillofacial diseases.

Biopsy

When the patient's clinical presentation, past history, or imaging studies do not allow for a definitive diagnosis, a biopsy is recommended. A biopsy is a surgical procedure that involves removing a sample of tissue from a living organism for microscopic examination. Biopsies are typically performed under local anaesthesia. Some biopsies are performed endoscopically, while others are performed under image guidance, such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) in the radiology suite. Oral and sinus mucosa, bone, soft tissue, skin, and lymph nodes are some of the most common tissues examined via biopsy.

The following biopsies are commonly used to diagnose oral and maxillofacial pathology:

Excisional biopsy:

A small lesion is completely removed. If the lesions are 1 cm or less in diameter, clinically and seemingly benign, and surgically accessible, this method is preferred. Large lesions that are more diffused and dispersed in nature, or that appear to be clinically malignant, are not amenable to total removal.

Incisional biopsy: A small portion of tissue from an abnormal-looking area is removed for examination. This method is useful for treating large lesions. If the abnormal area is easily accessible, the sample could be collected at your doctor's office. If the tumour is deeper inside the mouth or throat, a biopsy in an operating room may be required. To alleviate any pain, general anaesthesia is administered.

Cytology of exfoliation:

A suspected area is gently scraped to collect a cell sample for analysis. These cells are stained with dye and placed on a glass slide to be examined under a microscope. A deeper biopsy will be performed if any cells appear abnormal.

Diseases:

Oral and maxillofacial pathology can affect a wide range of head tissues. Different disease processes affect different tissues in this region, resulting in a variety of outcomes. Many diseases affect the mouth, jaws, and orofacial skin. The pathologies listed below are a general overview of those that can affect the oral and maxillofacial region; some are more common than others. This is by no means an exhaustive list.

Geographic variation:

In the United Kingdom, there are approximately 30 consultant oral and maxillofacial pathologists. A dental degree is required, but not a medical degree. In the United Kingdom, the shortest path to becoming an oral pathologist is to complete two years of general professional training followed by five years of diagnostic histopathology training. After passing the necessary Royal College of Pathologists exams and receiving a Certificate of Completion of Specialist Training, the trainee is eligible to apply for specialist registration. Many oral and maxillofacial pathologists in the United Kingdom are clinical academics, having completed a PhD prior to or during their training. In the United Kingdom, oral and maxillofacial pathologists are typically employed by dental or medical schools and perform clinical work at university hospitals departments.

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