Background The diagnosis of Sjogren Syndrome (SS), requires fulfillment of the American- European classification criteria, which include the obligatory presence of antibodies or a compatible histology. Numerous labial salivary gland biopsy techniques have been described, with variations in the size and shape of incision, as well as the need for suturing. Nowadays, the tendency is to use less invasive techniques
Objectives To evaluate the frequency of complications of the minimally invasive biopsy of minor salivary glands
Methods Transversal study of 159 biopsies of the minor salivary gland. Inclusion Criteria: patients with dry syndrome. Biopsy technique: anesthesia with ultracain and epinephrine, vertical incision (≤5 mm) of the internal surface of the lower lip using a scalpel and whitout suture, followed by the application of a gauze with topical procoagulant for 30 minutes. Variables studied: 1) clinical: age, sex, presence and duration of the symptoms; 2) diagnostic: Schirmer test, salivary scintigraphy, ANA, RF, anti-SSA and anti-SSB. 3) biopsy complications: a) immediate: bleeding and lipothymia; b) acute (<1 month): dysesthesia, hematoma, swelling, infection, pain, speaking and eating difficulties, scarring disorders (granuloma, keloid) and c) chronic (>1 month): dysesthesia, scarring disorders (granuloma, keloid), 4) histological: a) degree of atrophy: absent, light, moderate and severe b) Chisholm-Mason scale (I-IV)
Results The characteristics of the sample group were; age 59.9 ±12.43 years, 91% women, 88% xerostomia, 89% xerophthalmia for a period of 49±37 months, 45% positive salivary scintigraphy, 54% positive Schirmer, 54% ANA, RF 22%, anti-SSA and anti-SSB of 28% and 6.2%, respectively. The complications were: immediate (n=16; 8%): bleeding (n=13; 81%), lipothymia (n=3; 18%); b) acute (n=93; 58%): dysesthesia (n=2; 1.2%) for a period of 2.5±0.7 days, hematomas (n=23; 14%)) for a period of 4±2.5 days, swelling (n=69; 43%) for a period of 3±2.4 days, infection (0%), 37% pain (26% mild, 9% moderate, 2% severe) for a period of 3±2.5 days, speaking difficulties (n=13;8.1%) for a period of 3±3.6 days, eating difficulties (n=20; 12%) for a period of 2.3±2.8 days and granuloma (n=10; 6.2%); c) chronic (n=4; 2.5%): dysesthesia (0%) and granuloma (n=4; 2.5%) without clinical repercussion. Material for histology was obtained in 92.5%. The development of chronic complications (granuloma) was not related to the presence of acute complications except temporal dysesthesia (18% vs 1%; p<0.001). Also chronic complications was not related to the degree of histological atrophy or age, but a tendency was observed in younger patients (49±4.5 vs 60±12.4; p<0.09)
Conclusions The minimally invasive biopsy of the minor salivary gland is a technique which is easy to carry out and complications are rare. Moreover, it also offers success rates to obtain material which are similar to those of other techniques. Given the ease of the technique and the fact that complications are rare, it is worth evaluating its incorporation into those centres where it is not being used and it should be performed by rheumatologists.
Disclosure of Interest None declared