Bedside labial salivary gland biopsy (LSGBx: Lip biopsy): An update for rheumatologists

Retrieval of labial (minor) salivary glands from beneath the oral mucosa can be accomplished by a bedside procedure that can be performed by any physician who can close a simple laceration. Pathologies disclosed in the retrieved glands can help support a number of different diagnoses that might be encountered in rheumatology.

LSGBx is a bedside procedure utilizing only local anesthesia that can be performed by any physician with the minor surgical skills to repair a small laceration: incision through the epithelium, tissue manipulation, and simple suturing. Pathology of the minor salivary glands obtained is sought most often to support a suspected diagnosis of Sjögren's but a number of other disease processes can involve salivary glands, and obtaining tissue can support their diagnoses. Minor salivary glands, as easily obtainable target tissues, provide excellent substrates for basic investigations in Sjögren's and other diseases. In this review, we intend to describe the intricacies of salivary pathology in Sjögren's and discuss how it contributes to diagnosis, review other diseases where minor salivary gland pathology has been described to be useful for diagnosis, and describe the path to research efforts involving salivary glands. Then we will describe the procedure itself, providing a basic step-by-step how-to-do-it description. While we will describe mainly the approach we use, we comment on other variations that have appeared in the literature. Several large surveys have collected reports of complications from the procedure, and we will summarize those. The reader should come away with a better appreciation of why LSGBx is a worthwhile technique to learn and perform, what it is good for, and how to do it.

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