15.7.2 Lingual frena
A prominent lingual frenum should be excised if it is interfering with speech or oral
hygiene. This is simply performed under local anaesthesia. The frenum is held by a
pair of haemostatic forceps, a triangular section of tissue is removed, and the wound
ends sutured.
15.7.3 Mucoceles
Mucoceles are common in the second decade of life, although they occasionally occur
in younger children including the newborn. If these lesions cause functional or
emotional problems they should be excised, but if there is no disturbance removal
may be delayed until the child is older. An incision is made next to the lesion, which
is removed by a blunt dissection under the epithelium. Invariably a number of minor
salivary glands are obvious during surgery (they often appear like a bunch of grapes
around the mucocele). These should be removed in view of the fact that mucoceles
are produced as a result of trauma. Any obvious dental cause of trauma, for example,
a sharp tooth, should be remedied. One type of mucocele that is best referred for
specialist treatment is that found in the floor of the mouth, the so-called 'ranula' (1068HFig.
15.8). This lesion is often more extensive than is at first apparent and complete cure
occasionally involves removing the sublingual gland.
15.7.4 Incisional biopsy
Incisional biopsies are performed to confirm a diagnosis by removing part of a lesion.
It is preferable that the surgeon who is going to treat the lesion performs the incisional
biopsy and therefore this procedure is best performed by an oral surgeon.
15.7.5 Excision biopsies of non-attached mucosa
Small lesions of the oral mucosa are removed by excisional biopsy, which involves
the removal of an ellipse of tissue including the lesion. The long axis of the ellipse is
made parallel to the direction of muscle pull, and it is best to hold the specimen with a
suture passed under it to avoid crushing, which could render the specimen useless for
histological examination (1069HFig. 15.31). All tissue surgically removed should be placed
in a solution of 10% formal saline (not in water) and transported to the laboratory for
histological examination. Lesions that are obviously benign and are not interfering
with function or causing emotional distress can be left in the young child and
removed, if necessary, at a later date (1070HFig. 15.32 (a) and (b)).