return to: Lip Biopsy for Sjogren's Syndrome (Minor Salivary Gland Biopsy) Using Chalazion Clamp; Sjogren's Syndrome

complication: Complication From Lip Biopsy for Sjogrens with Mucocele Formation (Granulation Tissue)

Sequence of healing

Operation:

Postop 8 days and Postop 2 weeks

Postop one month

Modified Operative Note

Procedure: Left lower lip minor salivary gland biopsy

Preop Diagnosis: Rule out Sjogren's syndrome

Postop Diagnosis: Same

Surgeon: Hoffman

Assistant: XXX

Anesthesia: 4% topical lidocaine with 1% phenylephrine spray to the left gingival buccal sulcus followed by 1 cc of  2% lidocaine with 100,000 epinephrine injected for a mental nerve block allowing time and then placement of a chalazion clamp after prepping and draping the area with betadine swab

Description of Procedure: Following identification the patient informed consent and a brief timeout in the minor room the above-mentioned preparation including placement of a chalazion clamp allowed for an incision approximately 1-1/2 cm long along the course of the mental nerve to made through mucosa with identifying readily apparent minor salivary glands which were "teased" out by way of forceps and scalpel scraping approach allowing for view of a nerve that was left intact (a branch of the mental nerve was visualized and preserved) with closure then affected with a deep simple incorporating underlying muscle (avoiding the nerve) single suture that type in combination with more superficial sutures to close with employing 5-0 Vicryl.

She was observed with no sign of bleeding photographs were taken intraoperative and 8 separate minor salivary glands were teased out to be sent for pathology.

She tolerated the procedure well with Peridex given as a oral rinse in deference to her dental problems that could contribute some bacterial colonization suggesting either Aleve or ibuprofen if she were to have discomfort or application of ice as well

Modified Pathology Report:

Lip, salivary glands, biopsy: 
Minor salivary gland tissue with a focus score of <1.
Increased scattered plasma cells throughout tissue. 
See comment. 

Comment
An adequate number of salivary gland lobules are present for evaluation [14 minor salivary gland lobules identified, with a minimum number suggested to be 5-7]. At least 2 foci in approximately 9 sq mm of salivary gland tissue is seen, giving a focus score <1. While the histologic findings fall just short of those considered histologically compatible with Sjogren's, the there are other areas of the tissue where increased plasma cells and lymphocytes are seen which is not normal.

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.