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Lip biopsy for minor salivary gland (biopsy for Sjogren's syndrome)

last modified on: Sun, 12/06/2020 - 06:18

 

see also:Lip Biopsy for Sjogren's Syndrome (Minor Salivary Gland Biopsy) Using Chalazion Clamp Sjogren's SyndromeLip Biopsy of Minor Salivary Gland Histopathology for Sjogren's Syndrome (sjogren / sjogrens)

 and: Sjogren Syndrome PathologyComplication From Lip Biopsy for Sjogrens with Mucocele Formation (Granulation Tissue)

 

Lip biopsy of the minor salivary glands of the lip can be used in diagnosis of Sjogren’s syndrome.  Need to provide the pathologist with 3 – 5 minor salivary glands for examination. 

Consent: Lip biopsy under local anesthesia

  potential complications: bleeding, infection, reaction to the anesthetic, damage to adjacent structures.

Potential for development of mucocoele from interruption of adjacent minor salivary gland drainage, numbness in site of biopsy, inadequate tissue for diagnosis

Equipment:

  • Local anesthesia (see below), needles and syringes
  • Minor tray with: 15 blade, pick ups/tissue forceps, Steven’s scissors, Needle driver, Skin hooks, 4-0 Chromic or 4-0 vicrly for closure, Gauze, Cautery (Silver nitrate, Bipolar), Suction with Fraiser tip, Specimen container to send to path, Head light/Surgical light

Room positioning:

  • In oto minor room
  • Upright in dental chair
  • Mayo stand for supplies

Anesthesia: Local

  • Spray benzocaine spray or apply viscous lidocaine on a cotton ball to the lower lip mucosa
  • Inject the lower lip mucosa with 1% or 2% lidocaine with 1:100,000 epiphrine at desired spot of biopsy using a 27 gauge needle (0.5 cc – 1 cc should suffice)

Procedure:

After local anesthetic has set up make a horizontal or vertical incision to the lip’s long axis (surgeon preference) ~ 1 – 1.5 cm on the lower lip mucosa just lateral to midline while having the lip under stretch (assistant may be necessary).  Superficial to the muscle, identify minor salivary glands by the lobular nature.  Remove several readily available glands and place in specimen cup to send to pathology (on formalin).  Achieve hemostasis by holding pressure with gauze, silver nitrate cautery and/or electrocautery.  Close incision with interrupted simple stitch with 4-0 Chromic (1 or 2 stitches should suffice) or horizontal mattress to reapproximate the mucosal edges.  Regular oral care. 

see alternative approach using Chalazion clamp:Lip Biopsy for Sjogren's Syndrome (Minor Salivary Gland Biopsy) Using Chalazion Clamp

see recent (Oct 2020) discussion re: use of ultra-high frequency ultrasound of labial glands to assist in decision-making about lip biopsy (Ferro 2020)

Post op:

No antibiotics or pain medication necessary.

Complications:

Lower lip numbness

 Mucocoele (obstructed drainage to minor salivary gland in lip adjacent scar see: Complication From Lip Biopsy for Sjogrens with Mucocele Formation (Granulation Tissue))

Pain

Non-diagnostic biopsy (variable sensitivity for Sjogren’s syndrome)

    Note: questions persist about reliability and usefulness of lip biopsy (ref Bamba). Others suggest forgoing lip biopsy in that it adds little useful clinical information for those in whom the diagnosis is unlikely or where the diagnosis is clinically obvious (ref Lee 1999).

    see more detailed discussion of pros/cons to lip biopsy at: Sjogren's Syndrome

References

Bamba R, Sweiss NJ, Langerman AJ, Taxy JB and Blair EA: The Minor Salivary Gland Biopsy as a Diagnostic Tool for Sjorgren Syndrome.  Laryngoscope, 119:1922-1926, 2009

Lee M, Rutka JA, Slomovic AR, McComb J, Bailey DJ, and Bookamn AA: Establishing Guidelines for the role of minor salivary gland biopsy in clincial practice for Sjogren's syndrome. J Rheumatol  1998 Feb:25(2):247-53

Wijaya C, Ramli RR, Khoo SG.Dry surgical field minor salivary gland harvest using a chalazion clamp for sicca syndrome. J Laryngol Otol. 2019 May;133(5):419-423. doi: 10.1017/S002221511900077X. Epub 2019 Apr 22.\

Ferro F, Izzetti R, Vitali S, Aringhieri G, Fonzetti S, Donati V, Dini V, Mosca M, Gabriele M, Caramella D, Baldini C. Ultra-high frequency ultrasonography of labial glands is a highly sensitive tool for the diagnosis of Sjögren's syndrome: a preliminary study. Clin Exp Rheumatol. 2020 Jul-Aug;38 Suppl 126(4):210-215. Epub 2020 Oct 23. PMID: 33095145.