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Oral Surgery/Tongue biopsy


My husband went in for his cleaning in September with his dentist and he checked him with the velescope. I velescope showed a dark area on the left lateral area of his tongue which wasn't not very was not very easily seen under normal light. The dentist had him come back two weeks later to recheck. The area still was dark under fe velescope but was a little smaller and a little lighter. He suggested my husband see an oral surgeon. On Monday which will have been a month and half we went back to the dentist to recheck the area. The dark spot was still there maybe a little smaller. On Tuesday yesterday my husband had a biopsy on the side if his tongue with a oral surgeon who has a horrible bed side manor. I guess the dentist spoke with the surgeon prior to biopsy and he was suppose to share the velescope pics with him since the area was very hard to see in normal light. When the oral  surgeon came in the room I tried to point out the general area the dentist showed me. I couldn't see well and there wasn't a lesion very apparent. He started to want to tHe the biopsy from where my husband but his tongue the day before. He took was few millimeter area our on almost the underside of his tongue. My question is after taking a photo of the biopsy area the spot in which the dentist pointed out to me is still apparent. I called his dentist who said it was in the general area of the dark area in the velescope. He said it may just be a few millimeters off. My main concert is if the is who didn't have the velescope biopsied the wrong spot even just a few millimeters off will it still detect some sign of abnormality if cancer is present even if it's not the exact dark area? I am just besides myself that these doctors are so stubborn and not communicating that well to each other or us. His dentist told me not to worry and just wait on the biopsy results. He will not go back until the 25th for his recheck and biopsy results. He had the frost biopsy on the same side if his tongue but farther up and farther back on 1-2012 by a local ent. I just remember that ent saying that you can biopsy one spot and it not show cancer but still have cancer a millimeter over. So of course my anxiety is kicking in they took the sample from the wrong area of the tongue. He will not go back in for another biopsy bc he is in extreme pain now. I don't know who is right and who is wrong. So my question us will cancer cells show up if the biopsy was taken a few millimeters off from the ark area under the velescope?

Velescope image sept 18, 2013

Velescope image 10-14-2013

Biopsy taken 10-15-2013

The arrow is pointing to the spot I thought the dentist said was where was dark under the velescope which is still there on his tongue. I can't make out the area on the velescope images bc they are so close up.i think the dentist said what was apparent under normal light was a small red area with a white outline. The os also said he removed just a small red area about the size of an eraser without a white outline and it was a littler redder than the normal pink surrounding tissue.

I am so very confused and unable to consult either dentist or surgeon at this time bc there busy. I appreciate your time to look and give me your opinion. Thanks.

ANSWER: Kim -  If the biopsy if off, even a small amount, it will not show that the cells indicate any pathology.  From the pictures I cannot tell if the biopsy was done in exactly the correct position.  Just wait and see the results before driving yourself crazy.

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QUESTION: I tried to call and speak with the dentist because he is the one who knows exactly where the dark area is. He didn't call me back but his receptionist emailed me and said that it is in the area and maybe a few millimeters off. SO now I am wondering why first there was so much of a lack of communication. You would think before someone would cut something out of a person tongue they would be 100 percent positive as to where the suspected lesion is. I guess by looking at the photos there is such a large dark area. I called an spoke with the receptionist and she said well as long as they did the biopsy in the general area it wil show if there is any abnormal cells present,but your saying that is not true? It would have to be 100 percent dead on? I just wish the dentist would take a little bit of time and call me back. I am trying not to drive myself crazy but this is huge deal. Depending on what the results say I am going to automatically second guess them knowing that the biopsy wasnt taken in the correct location, even if it was only a few millimeters off.

ANSWER: Kim - What I said is if the biopsy is off a small amount.  Small I a relative term, but if the area that is being biopsied is not a general area, but a specific area, then being off often will not provide the appropriate biopsy cells to evaluate a specific area.  A knowledgeable surgeon knows that if they are not sure that they got the exact location, a number of sites or a wider size of the biopsy would be appropriate.

The doctor may have gotten the correct area, so wait and see the results.

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QUESTION: I did end up talking with his dentist who looked at the picture I sent of the area which was biopsied. He said by what he can tell that the surgeon biopsied in the correct area. It seems to me that by the size of the incission on his tongue that a large portion of tissue was removed. I know the surgeon said that he was taking out a red circle area about the size of a pencil eraser but the area he stiched up is probaly over 2 cm long. I am hoping he took out enough to get the right sample. I know my husband will not put himself through this again. So are you saying that he should know by looking at the photos and talking with his dentist which area to remove and if he didn't know the exact area then he should have removed a larger area? With the incission being so large does that mean he removed a piece of tissue that large also? How do we know if he got the right are depending on the results? I guess if the biopsy comes back negitive for cancer then I will always have that thought that the wrong area was biopsied. Is this an unjustified thought?

Kim -  let me tell you that from the incision made, it is pretty obvious, especially from the location of the sutures placed, that the surgeon extended his incision for two reasons.  One is to make sure that he took enough tissue to make sure the area he was taking included any evidence of pathological cells.  The second reason is to facilitate closing of the wound so no long term defect exists, as opposed to a punch biopsy that leaves a "hole".

So relax, the doctor did the correct thing by extending his incision to be sure any pathology was incorporated.

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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