Sjögren’s syndrome is characterized by chronic inflammation of the glands that produce saliva and tears. An important method for establishing the diagnosis is to take a biopsy of these glands in order to determine whether inflammation is present, and if so, its type and severity. The minor salivary glands just under the inner surface of the lip are the most accessible of these glands. (These are the “cobblestones” that you can feel when you rub your tongue along the inner surface of your lower lip.) In performing a lip biopsy, the surgeon typically makes a shallow 1/2 inch incision on either side of the inner lip after numbing the area with a local anesthetic. Approximately 5-7 glands are plucked out with sterile tweezers. The incision is then closed with resorbable sutures. There may be soreness of the lip for a few days after the surgery. Approximately 1-2% of individuals will notice numbness of the lip in the area of the surgery for a period of 2-3 months.
The lip biopsy has to be interpreted by a pathologist with special training. The lesion in Sjogren’s syndrome is termed “focal lymphocytic sialoadenitis” and is characterized by one or more tightly aggregated lymphocytes (more than 50) adjacent to normal gland tissue and surrounding a duct in a 4 square mm area of gland tissue. These aggregates of lymphocytes are called foci and their total density is called a “focus score”. The lip biopsy may reveal other types of glandular inflammation and point to alternative diagnoses, such as sarcoidosis or lymphoma.
For more information about what to expect, how to prepare and instructions after the biopsy click this link: Lip Biopsy Info