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 the salivary 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 wide incision on either side of the inner lip after numbing the area with a local anesthetic. Approximately 5-7 glands are then gently removed with sterile tweezers. The incision is then closed with resorbable sutures. There may be soreness of your 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 specialized training. The characteristic biopsy finding in Sjögren’s syndrome is “focal lymphocytic sialoadenitis” and is recognized by the presence of one or more tight clumps of lymphocytes (more than 50 in number) adjacent to normal gland tissue and surrounding a duct in a 4 square mm area of gland tissue. These clumps of lymphocytes are called foci and their approximate density in the tissue is called a “focus score”. The lip biopsy may reveal other types of glandular inflammation and point to alternative diagnoses, such as sarcoidosis, amyloidosis or lymphoma.
For more information about what to expect, how to prepare, and instructions for after the biopsy please follow this link: Lip Biopsy Info