As part of your evaluation for Sjögren’s syndrome, a lip biopsy has been recommended. This information will answer common questions related to this biopsy procedure.
What is a minor salivary gland (lip) biopsy?
A minor salivary gland biopsy is recommended to help make the diagnosis of Sjögren’s syndrome. The biopsy provides important information about the degree of destruction of the salivary glands and helps guide therapy. The biopsy alone does not make the diagnosis.
What are the risks?
There is a small risk that you will develop numbness at or near the biopsy site on the inside of your mouth. This numbness is usually temporary; however in rare cases this can be permanent. In addition, a small scar may form at the site of the incision which can be numb.
There is also a risk that the biopsy tissue may be inadequate or “not enough” because:
There is a lack of glands at the biopsy site. There is no way to identify this in advance.
An adequate amount of tissue is obtained, but lab can only find a small amount of glandular tissue in the specimen. There is no way this can be determined with the naked eye during the actual procedure.
What will happen during a lip biopsy?
The minor salivary glands are just under the inner surface of the lip and are the most accessible for biopsy. You have around 1,000 minor salivary glands in the lining of your mouth that produce mucus and saliva to keep your mouth moist. You can feel these glands if you rub your tongue over the inside of your lower lip. The glands feel like cobblestones.
In performing a lip biopsy the provider will turn down the lower lip. Numbing medication (lidocaine with epinephrine) is injected into the site which will burn for a few seconds, but then will become numb. A shallow ~2 cm incision will be made. About 3-5 glands are gently removed. The lip is very vascular and may be cauterized if needed. The incision is then closed with 3-4 stitches that will dissolve within a week. There may be soreness of your lip for a few days after the procedure.
How do you prepare for the procedure?
Discontinue any blood thinners like warfarin (Coumadin®) at least 5 days prior to the biopsy. Please consult with your prescribing provider for instructions. You may continue to take aspirin.
Let us know if you have an allergy to lidocaine or epinephrine which will be used to numb your lip
Let us know if you have an allergy to iodine or shellfish which may be used to clean your lip before the biopsy.
What to expect after the lip biopsy?
Right after the biopsy, your lip will feel very “large” and numb due to the numbing medication. This sensation will wear off within one hour. You may drink immediately after your biopsy, please make sure you let hot drinks cool down. You may eat 1-2 hours after the biopsy; avoiding hard or sticky foods.
If there is any pain, we recommend applying some ice to the area to decrease the swelling. Do this by wrapping some ice cubes or an ice pack in a towel and holding it to the area for 10 minutes. You may also take Tylenol every 4-6 hours for pain relief. Do not exceed 3,000 mg in a 24 hour period.
You may feel the stitches inside of your mouth. These feel like “whiskers” that will soften throughout the day. If the stitches do not dissolve within the week, see your local dentist or primary doctor for simple removal of the stitches. You are also always welcome to return to our clinic to remove them.
If your stitches fall out early and you are not bleeding, this is OK. If bleeding occurs, use gauze to apply pressure to the area for 10-15 minutes. If the bleeding persists, please contact National Jewish Health at 303.398.1355.
Silver nitrate may have been used to cauterize bleeding during your procedure. This will cause black or discolored tissue at the biopsy site. Do not be alarmed as the tissue will return to normal as the site heals.
Gargle or swish your mouth with warm salt water (dissolve a teaspoon of ordinary salt in a cup of warm water) after each meal for one week. This keeps the wound clean and prevents infection.
Do not smoke for at least 72 hours as this increases your chance of developing a wound infection.