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Minor Salivary Gland Biopsy
(for Sjögren’s Syndrome Diagnosis)
In suspected cases of Sjögren’s Syndrome, patients
are often referred for a
lower lip minor salivary gland
biopsy
.

The minor salivary gland biopsy by itself will not diagnose
Sjögren’s Syndrome but adds to the clinical picture (by the
time the biopsy happens, the patient would have already
had a number of other clinical, blood, functional and
morphological investigations [as laid out by the
American-
European Consensus Group]).

Biopsy of the minor salivary glands of the lower lip has
been used for many years as the changes in the lower lip
mirror those in the major salivary glands (
parotid and
submandibular glands).  The presence of chronic
inflammatory cells in lip salivary glands, as assessed with
the
minor salivary gland biopsy, is one of the parameters
included in most criteria sets proposed for
Sjögren’s
Syndrome
classification.

What is a Minor Salivary Gland Biopsy & How Is It Done?

A Minor Salivary Gland biopsy is a procedure where an
incision is made within the lower lip and
minor salivary
glands
present just below the surface are plucked out and
looked at closely under a microscope.  It is a relatively
minor and safe procedure.

A
local anæsthetic injection is used to numb the area which
takes a couple of minutes to work.  After this injection, the
procedure should be painless.  An incision, needing
stitching afterwards, is made to the lower lip.  The stitches
dissolve after 10 -14 days.  All together, this procedure
usually takes around 15 - 20 minutes from start to finish.

Is there much soreness afterwards?

When the anæsthetic wears off, there will be some pain
and discomfort.  Simple painkillers will usually be effective.  
You will be advised which are the best to take.  Any
discomfort usually only lasts a few days.

Will there be much bleeding?

Although there may be a little bleeding at the time of the
biopsy, this usually stops very quickly and is unlikely to be
a problem if the wound is stitched.

When you get home, should the biopsy site bleed again,
apply pressure over the area for at least 10 minutes with a
rolled up handkerchief or swab (if you have been given
one).  This should stop the bleeding but if the bleeding
continues please contact your Oral Surgeon / OMFS
Department.

When can I return to work?

This largely depends on your job and how you feel after the
procedure.  Most people are able to return to work later
the same day.

Will I need another appointment?

A follow-up appointment is not always necessary but you
will usually be asked to attend an appointment for the
results of the biopsy to be discussed with you.  A care
advice leaflet will be given to you after the biopsy.


Minor Salivary Gland Biopsy - Operation Warnings

Pain.  As it is a surgical procedure, there will be soreness
after the procedure.  This can last for several days.  
Painkillers such as
ibuprofen or paracetamol are very
effective.  Obviously, the analgesic you use is dependent
on your medical history and the ease with which the biopsy
was carried out.

Swelling.  There will be swelling afterwards.  Avoidance in
the first few hours post-op, of alcohol, exercise or hot
foods / drinks will decrease the degree of swelling that will
develop.

Stitches.  The biopsy site will be closed with stitches.  
These are dissolvable and ‘fall out’ within 10 – 14 days.

Scarring / Lumpiness at Biopsy Site.  Any cut to soft
tissues produces a scar.  Initially, after a biopsy, a scar will
be produced.  This softens and disappears (i.e. improves)
with time.  Regardless, it can feel quite obvious and lumpy
to begin with.  The scarring can also dependent on the size
and size of the biopsy and the individuals’ tendency to
scarring.

Initial Tautness / Tenderness at Biopsy Site.  To close the
biopsy site, the wound margins are closed with stitches.  
These place tension and hence tenderness at the biopsy
site; this tails off with time.

Localised Area of Numbness at Biopsy Site.  The biopsy
can damage the local nerves resulting in areas of
numbness.  These can take a number of months before
normal feeling returns.

Inconclusive Results & the Need for Re-biopsy.  The biopsy
results can come back as inconclusive.  If this is the case,
then it is possible that the biopsy will need to be repeated.

Further treatment dependent on Results.  Depending on
what the biopsy results are, will determine whether further
treatment is required.


Websites:

NHS Direct

Sjögren’s Syndrome Society

British Sjögrens Syndrome Association        

Patient UK

Revised International Classification Criteria for Sjögren's
Syndrome


Articles:

Ann Rheum Dis 2002.  CONSENSUS REPORT.  
Classification criteria for Sjögren’s syndrome: a revised
version of the European criteria proposed by the American-
European Consensus Group.

Annals of Rheumatic Diseases 1992.  Complications
associated with labial salivary gland biopsy in the
investigation of connective tissue disorders.

The Laryngoscope 2009.  The Minor Salivary Gland Biopsy
as a Diagnostic Tool for Sjogrens Syndrome
Last Updated 17th August 2010