Key Points
- Diagnostic procedure for salivary gland pathology
- Minor salivary gland biopsy preferred in pediatrics
- Usually performed from lower lip
- Local anesthesia required
- High diagnostic yield when performed correctly
Clinical Indications
- Suspected Sjögren's syndrome
- Unexplained xerostomia
- Salivary gland masses
- Recurrent parotitis
- Chronic sialadenitis
- Granulomatous conditions
- Salivary gland tumors
Anatomical Considerations
Major Salivary Glands
- Parotid gland
- Located anterior to ear
- Contains facial nerve
- Produces serous secretions
- Submandibular gland
- Located in submandibular triangle
- Mixed mucous and serous secretions
- Near lingual nerve
- Sublingual gland
- Located in floor of mouth
- Primarily mucous secretions
Minor Salivary Glands
- 600-1000 glands distributed throughout oral cavity
- Highest concentration in lower lip
- Rich in diagnostic information
- Easier access for biopsy
Procedure Protocol
Pre-procedure Assessment
- Complete medical history
- Bleeding parameters
- Informed consent
- Fasting status if needed
- Mark biopsy site
Equipment Required
- Sterile surgical set
- Local anesthetic
- 4-0 or 5-0 absorbable sutures
- Specimen containers with formalin
- Gauze and pressure packs
- Surgical microscope (if needed)
Step-by-Step Technique
- Position patient supine with proper lighting
- Apply topical anesthetic
- Infiltrate with local anesthetic
- Make 1-1.5cm horizontal incision
- Careful dissection to expose glands
- Obtain 4-5 minor salivary glands
- Ensure hemostasis
- Close with interrupted sutures
- Apply pressure dressing
Complications and Management
Immediate Complications
- Bleeding
- Apply direct pressure
- Additional sutures if needed
- Hemostatic agents available
- Pain
- Age-appropriate analgesia
- Cold compression
- Nerve injury
- Document sensory changes
- Follow-up monitoring
Late Complications
- Scarring
- Numbness
- Mucocele formation
- Wound dehiscence
Post-procedure Care
- Ice pack application
- Soft diet for 24-48 hours
- Oral hygiene instructions
- Follow-up schedule
Pathological Considerations
Specimen Handling
- Immediate fixation in formalin
- Proper labeling
- Orientation marking if needed
- Transport to laboratory
Common Histopathological Findings
- Normal architecture
- Lymphocytic infiltration
- Fibrosis
- Acinar atrophy
- Ductal changes
- Granulomas
Special Studies
- Immunofluorescence
- Immunohistochemistry
- Flow cytometry
- Molecular studies
Further Reading
