Minor Salivary Gland (MSG) Biopsy

Minor salivary gland (MSG) biopsy of the lower lip mucosa is used to confirm the diagnosis of Sjogren’s syndrome.  Sjogren’s is a chronic autoimmune disorder involving the destruction of glandular tissue.

Sjögren’s syndrome can cause dry mouth, skin, nose, and vaginal dryness, and may affect other organs of the body, including the kidneys, blood vessels, lungs, liver, pancreas, peripheral nervous system (distal axonal sensorimotor neuropathy), and brain.

Patients with Sjögren’s syndrome commonly also exhibit signs and symptoms of their primary rheumatic disorders, such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis or Systemic Sclerosis.

While minor salivary gland biopsies are not usually described as the definitive test for Sjogrens, it is, based on comparative research which looks at the accuracy of salivary flow testing, ENA testing and MSG Biopsy. An additional confirmatory test for Sjogrens syndrome is serology testing using the extractable nuclear antigen (ENA) antibody test, also called the SSA (Ro) and SSB (La) antibody test.

Related Reading: Management of Dry Mouth in Older Patients

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Indications of Sjogren’s Disease

When patients indicate symptoms of generalized dryness of the mouth, dry eyes (keratoconjunctivitis sicca), vaginal dryness, chronic bronchitis, and unexplained swelling or enlargement of the major salivary glands (parotid and/or submandibular) it is clinically suggestive of Sjogren’s disease.

Contraindications

There are no contraindications assuming normal lip mucosa and normal healing and clotting is present.  Complications from the procedure are unlikely, however the following side effects have been reported:

• Slight pain and swelling associated with the surgical site (resolving within 3 weeks)
• Localized anesthesia (reduced sensations) of the lower lip for several months
• Abnormal healing reaction such as a pyogenic granuloma of the biopsy wound
• External hematoma at the surgical site
• Internal mucosal scarring
• Adrenaline-induced tachycardia
• Local wound site infection
• Immediate suture failure requiring resuturing

Related Reading: The Dentist’s Guide to Oral Pathology of Vesicular Ulcerative Conditions

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Minor Salivary Gland (MSG) Biopsy Procedure

1. Use a medium size chalazion clamp to hold the lip.
2. Use a surgical pen to mark the papules of the minor salivary glands.
3. Perform a horizontal incision (5 mm long).
4. Blunt dissect the incision using surgical scissors to release the epithelium from the underlying connective tissue.
5. After the blunt dissection, the minor salivary gland lobules will be prominent.
6. Use tissue forceps to hold the minor salivary gland lobules and cut them free with scissors or a scalpel blade.

Related Reading:  How to Conduct an Incisional Oral Biopsy

Post-Operative Biopsy Care Instructions

For pain control, prescribe NSAIDs or acetaminophen, and encourage the patient to apply ice-packs if they do not want to take medications.  For any oral biopsies, it is advisable to instruct the patient to take one tablet of analgesic before the anesthesia wears-off.  If you do not hold any analgesics in your office, advise the patient to bring in the medication which they usually take when they have pain on the day of the biopsy.  Lastly, in most case antibiotics are not needed following a minor salivary gland biopsy.

Because bleeding can occur for a couple of days after the procedure, instruct the patient to apply direct pressure for 15 minutes using gauze or a tissue to stop the bleeding.  If the wound continues to bleed, instruct the patient to contact the dental clinic.

Swelling and bruising is uncommon with this biopsy because the surgical injury is so minor.  If swelling does occur, the peak of the swelling is generally 3 to 4 days after the procedure, after which it gradually subsides. When in doubt return to the clinic for evaluation.

Any non-resorbing sutures must be removed 1 week after the biopsy.  At this 1 week follow-up visit, the biopsy results should be available to report to the patient.

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