see full technique: Lip Biopsy for Sjogren's Syndrome (Minor Salivary Gland Biopsy) Using Chalazion Clamp

expected healing: Sequence of Healing After Lip Biopsy for Sjogren's Syndrome (Minor Salivary Gland Biopsy)

mucocele complication from lip biopsy: Complication From Lip Biopsy for Sjogrens with Mucocele Formation (Granulation Tissue)

Background

The mental nere is a terminal branch of the third division of the trigeminal nerve (mandibular branch) and provides sensory innervation to thoral mucosa, lower lip, and skin of the chin ventral to the mental foramen (Nguyen 2023).

Modified Operative Note

Procedure: Minor salivary gland biopsies (left lower lip biopsy)

Preop Diagnosis: Possible Sjogren syndrome

Postop Diagnosis: Same

Anesthesia: Topical 2% viscous lidocaine applied to the left gingival buccal sulcus followed by 2% lidocaine with 1 200,000 epinephrine injection for a left mental nerve block (initially 1 cc supplemented with another 1/2 cc)

Description of Procedure: Following identification the patient informed consent and a brief timeout in the minor room following the above-mentioned anesthesia Betadine Toothette swabs were used to prep the lower face as well as internal mouth in the region of the left lip biopsy.

A chalazion clamp was then applied as a "tourniquet" exposing the inner aspect of the left lower lip with surrounding pressure allowing for an incision along the course of the mental nerve through mucosa to identify minor salivary gland lobules removed x 7 (see photo below) with care to identify and preserve nerve branches employing a technique of picking up the lobule with forceps and scraping away the lobule from adjacent tissue with the side of the scalpel blade.

The wound was then closed with 3 separate deeper sutures that were placed with care to avoid nerve branches with the middle 1 incorporating a small bit of muscle and then tied (5-0 Vicryl) with 3 very superficial 5-0 Vicryl was then placed afterwards.

She tolerated the procedure well with essentially no blood loss and was discharged home with follow-up arranged asking her to contact us for the final pathology assessment.

References

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

Nguyen JD, Duong H. Anatomy, Head and Neck, Mental Nerve. 2023 May 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31536237.

Betz D, Fane K. Mental Nerve Block. 2023 Jan 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29489259.