Who performs an oral lesion biopsy, is it an Ear, Nose, and Throat (ENT) specialist?

Who Performs Oral Lesion Biopsies

Multiple specialists can perform oral lesion biopsies, including oral and maxillofacial surgeons, oral medicine specialists, ENT (otolaryngology) specialists, dentists with appropriate training, and dermatologists for certain lesions—the choice depends on the lesion location, complexity, and local expertise. 1

Primary Specialists Who Perform Oral Biopsies

Oral and Maxillofacial Surgeons

• These are the most common providers for oral cavity biopsies in dental practice settings 2, 3
• Trained specifically in surgical procedures of the oral cavity and have expertise in tissue handling and anatomic considerations 3
• Particularly appropriate for complex lesions, deeper tissue sampling, or when surgical expertise is needed 2

Oral Medicine Specialists

• Specifically trained in diagnosis and non-surgical management of oral mucosal diseases 1
• Often perform biopsies as part of their diagnostic workup 1
• May collaborate with oral pathologists for optimal specimen handling 4

ENT (Otolaryngology) Specialists

• Appropriate for oral cavity lesions, particularly when there is involvement of the pharynx, larynx, or when fiber-optic endoscopy is needed 1
• Pediatric guidelines specifically state that pediatric otolaryngologists should manage oral cavity infections and congenital malformations requiring biopsy 1
• For mucosal leishmaniasis, guidelines explicitly recommend that "biopsy specimens, obtained by an otolaryngologist, are useful for confirming the diagnosis" 1

General Dentists

• Can perform oral biopsies but practice is not widespread, often due to lack of experience and confidence 5
• A study found that while 96.2% of dental surgeons encountered lesions requiring biopsy, only 7.5% actually performed them, primarily due to lack of experience and skill 5

Dermatologists

• May perform punch biopsies of oral lesions, particularly when there is concurrent skin involvement 6
• The American Academy of Dermatology recommends punch biopsy as the preferred technique for full-thickness specimens 6

Decision Algorithm for Referral

Location-based considerations:

• Anterior oral cavity (lips, anterior tongue, buccal mucosa): Oral and maxillofacial surgeons or oral medicine specialists are most appropriate 2, 3
• Posterior pharynx, soft palate, or requiring endoscopy: ENT specialists are preferred 1
• Lesions with skin involvement: Dermatologists may be appropriate 6

Complexity-based considerations:

• Simple mucosal lesions: Can be performed by trained general dentists, oral medicine specialists, or oral surgeons 5, 3
• Suspected malignancy or premalignancy: Should be referred to specialists (oral surgeons, ENT, or oral medicine) for optimal tissue sampling 2, 7
• Deep or extensive lesions: Oral and maxillofacial surgeons or ENT specialists depending on location 2, 3

Critical Technical Considerations

Sampling adequacy is crucial:

• Larger biopsy volumes correlate with diagnostic accuracy—concordant cases averaged 1.53 cm³ versus 0.42 cm³ for discordant cases 2
• Sixty percent of diagnostic errors are due to sampling error when tissue is not representative of the entire lesion 2
• Multiple-site biopsies improve diagnostic accuracy 2

Common pitfalls to avoid:

• Clinical impression alone is insufficient—only 61% concordance between clinical and histologic diagnosis overall 7
• Clinical diagnosis is only 48.6% sensitive for identifying premalignant/malignant lesions, though 98.1% specific 7
• Patients with radiation therapy history, male gender, and older age have higher discrepancy rates and require timely biopsy 7

Special Populations

Pediatric patients:

• Should be referred to pediatric otolaryngologists, though pediatric plastic surgeons, pediatric surgeons, or pediatric oromaxillofacial surgeons with appropriate training are also acceptable 1

Patients with suspected systemic disease:

• May require coordination between multiple specialists (e.g., rheumatologists for Sjögren's syndrome, infectious disease for leishmaniasis) 1

Brain abscess patients with oral/dental source:

• Require consultation by ENT specialists and maxillofacial surgeons when oral cavity bacteria are identified 1