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Surgical Pearl: “X” marks the spot for the salivary gland biopsy
122 Pearls
J AM ACAD DERMATOL JULY 2001
Surgical Pearl: “X” marks the spot for the salivary gland biopsy Tina M. Peloro, MD, Michael L. Ramsey, MD, and Victor J. Marks, MD Danville, Pennsylvania
L
abial salivary gland biopsies are useful in the diagnosis of amyloidosis and Sjögren’s syndrome. Techniques described in the literature include 1.5- to 2.0-cm linear incisions of the inner lower lip,1,2 1-cm elliptical incisions with the use of chalazion forceps,3 and 3- to 4-mm longitudinal incisions of the labial mucosa in front of the mandibular canine tooth.4,5 We present a highly effective variation of the labial salivary gland biopsy that provides adequate sampling with a simple and time-efficient technique.
the salivary glands by placing a dot directly on the yellow papules (Fig 1). Anesthesia is locally injected. A No. 11 blade is used to make a superficial stab incision (1.5-2 mm) through one area identified by the marking pen (Fig 2). To facilitate removal of the salivary gland, a second stab incision is made perpendicular to the first incision making an “X” overlying the gland. The open blades of scissors are used to
TECHNIQUE The lower lip is manually everted and the mucosa is stretched. With the assistance of bright lighting, the labial salivary glands are identified as subtle yellow papules. A surgical marking pen is used to mark
From the Section of Mohs Surgery, Geisinger Health System. Reprints not available from authors. J Am Acad Dermatol 2001;44:122-3. Copyright © 2001 by the American Academy of Dermatology, Inc. 0190-9622/2001/$35.00 + 0 16/74/112924 doi:10.1067/mjd.2001.112924
Fig 2. A stab incision is made overlying the salivary glands.
Fig 1. A surgical marking pen is used to identify the salivary glands.
Fig 3. Labial salivary glands easily protrude through the stab incisions made in the form of an “X”.
J AM ACAD DERMATOL VOLUME 45, NUMBER 1
Pearls 123
the incisions decreases postanesthesia pain and healing time and precludes the need for sutures. The formation of two perpendicular incisions in the shape of an “X” provides an opening through which the labial salivary glands easily protrude. Manipulation and dissection are not necessary to gain access to the glands. The ease with which the labial minor salivary glands can be obtained with this simple technique renders it an ideal procedure with minimal operative time and quick healing.
Fig 4. Salivary glands are cut at the base.
apply pressure laterally to the stab incisions. The labial salivary glands easily extrude through the opening (Fig 3). Forceps are used to raise the yellow papules and the base is cut with scissors (Fig 4). The technique is repeated 3 to 4 times on additional premarked glands. Pressure is applied with a dental roll. Sutures are not necessary because of the small size of the stab incisions.
REFERENCES 1. Abaza N,Torreti M, Miloro M, Balsara G.The role of labial salivary gland biopsy in the diagnosis of Sjögren’s syndrome: report of three cases. J Oral Maxillofac Surg 1993;51:574-80. 2. Greenspan JS, Daniels TE, Talal N, Sylvester RA. The histopathology of Sjögren’s syndrome in labial salivary gland biopsies. Oral Surg 1974;37:217-29. 3. Seoane J, Varela-Centelles PI, Diz-Dios P, Romero M. Use of chalazion forceps to ease biopsy of minor salivary glands. Laryngoscope 2000;110:486-7. 4. Hachulla E, Janin A, Flipo RM, Saïle R, Facon T, Bataille D, et al. Labial salivary gland biopsy is a reliable test for the diagnosis of primary and secondary amyloidosis. Arthritis Rheum 1993; 36:691-7. 5. Lechapt-Zalcman E, Authier FJ, Creange A, Voisin MC, Gherardi RK. Muscle Nerve 1999;22:105-7.
DISCUSSION We describe a simple method of sampling labial salivary glands with stab incisions. The small size of
Direct all Surgical Pearl submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
Direct all Medical Pearl submissions to Dr Mark G. Lebwohl, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1048, New York, NY 10029.
J AM ACAD DERMATOL JULY 2001
Surgical Pearl: “X” marks the spot for the salivary gland biopsy Tina M. Peloro, MD, Michael L. Ramsey, MD, and Victor J. Marks, MD Danville, Pennsylvania
L
abial salivary gland biopsies are useful in the diagnosis of amyloidosis and Sjögren’s syndrome. Techniques described in the literature include 1.5- to 2.0-cm linear incisions of the inner lower lip,1,2 1-cm elliptical incisions with the use of chalazion forceps,3 and 3- to 4-mm longitudinal incisions of the labial mucosa in front of the mandibular canine tooth.4,5 We present a highly effective variation of the labial salivary gland biopsy that provides adequate sampling with a simple and time-efficient technique.
the salivary glands by placing a dot directly on the yellow papules (Fig 1). Anesthesia is locally injected. A No. 11 blade is used to make a superficial stab incision (1.5-2 mm) through one area identified by the marking pen (Fig 2). To facilitate removal of the salivary gland, a second stab incision is made perpendicular to the first incision making an “X” overlying the gland. The open blades of scissors are used to
TECHNIQUE The lower lip is manually everted and the mucosa is stretched. With the assistance of bright lighting, the labial salivary glands are identified as subtle yellow papules. A surgical marking pen is used to mark
From the Section of Mohs Surgery, Geisinger Health System. Reprints not available from authors. J Am Acad Dermatol 2001;44:122-3. Copyright © 2001 by the American Academy of Dermatology, Inc. 0190-9622/2001/$35.00 + 0 16/74/112924 doi:10.1067/mjd.2001.112924
Fig 2. A stab incision is made overlying the salivary glands.
Fig 1. A surgical marking pen is used to identify the salivary glands.
Fig 3. Labial salivary glands easily protrude through the stab incisions made in the form of an “X”.
J AM ACAD DERMATOL VOLUME 45, NUMBER 1
Pearls 123
the incisions decreases postanesthesia pain and healing time and precludes the need for sutures. The formation of two perpendicular incisions in the shape of an “X” provides an opening through which the labial salivary glands easily protrude. Manipulation and dissection are not necessary to gain access to the glands. The ease with which the labial minor salivary glands can be obtained with this simple technique renders it an ideal procedure with minimal operative time and quick healing.
Fig 4. Salivary glands are cut at the base.
apply pressure laterally to the stab incisions. The labial salivary glands easily extrude through the opening (Fig 3). Forceps are used to raise the yellow papules and the base is cut with scissors (Fig 4). The technique is repeated 3 to 4 times on additional premarked glands. Pressure is applied with a dental roll. Sutures are not necessary because of the small size of the stab incisions.
REFERENCES 1. Abaza N,Torreti M, Miloro M, Balsara G.The role of labial salivary gland biopsy in the diagnosis of Sjögren’s syndrome: report of three cases. J Oral Maxillofac Surg 1993;51:574-80. 2. Greenspan JS, Daniels TE, Talal N, Sylvester RA. The histopathology of Sjögren’s syndrome in labial salivary gland biopsies. Oral Surg 1974;37:217-29. 3. Seoane J, Varela-Centelles PI, Diz-Dios P, Romero M. Use of chalazion forceps to ease biopsy of minor salivary glands. Laryngoscope 2000;110:486-7. 4. Hachulla E, Janin A, Flipo RM, Saïle R, Facon T, Bataille D, et al. Labial salivary gland biopsy is a reliable test for the diagnosis of primary and secondary amyloidosis. Arthritis Rheum 1993; 36:691-7. 5. Lechapt-Zalcman E, Authier FJ, Creange A, Voisin MC, Gherardi RK. Muscle Nerve 1999;22:105-7.
DISCUSSION We describe a simple method of sampling labial salivary glands with stab incisions. The small size of
Direct all Surgical Pearl submissions to Dr Stuart J. Salasche, 5300 N Montezuma Trail, Tucson, AZ 85750.
Direct all Medical Pearl submissions to Dr Mark G. Lebwohl, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1048, New York, NY 10029.