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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
The minor salivary gland biopsy by itself will not diagnose
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.
Last Updated 5th December 2014
Useful Websites:

NHS Direct

Sjögren’s Syndrome Society

British Sjögrens Syndrome Association        

Patient UK

Revised International Classification Criteria for Sjögren's Syndrome


Useful 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.

Rheumatology 2010.  Salivary Gland Biopsy.  A Comprehensive Review of
Techniques & Related Complications
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

This list of warnings might seem excessive to some however the legal ruling in the
case of
Chester vs Afshar (2004) would suggest that it is quite prudent /
necessary to list them.  Others might say that there isn't enough information but
where do you stop?

The following list of warnings regarding
minor salivary gland biopsies is neither
exhaustive nor is it predictive.

The most pertinent warnings have been included here.

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.