Oral Surgery/biopsy of salivary gland
QUESTION: I recently had a biopsy of the salivary glands to dx Sjogrens. The first incision was made behind the lower lip near the area where the teeth meet the gum line. The doctor said that was the area she always uses. She was not able to find ANY glands there. She had to make an incision higher up the gums to find salivary glands. She said that this was only the second time this had happened. Is it unusual to find no glands? Could this be indicative of Sjogrens? I am waiting for the biopsy results.
The area by the lower incision does not hurt at all. Four days after the surgery, the area higher up does not hurt but I feel as if I have a fat lip and sometimes when I drink from a glass, I dribble a bit. Is this normal?
ANSWER: Roxy - Salivary glands are not really often located in the gum area, but small incisions in the lower lip area, just slightly inside the mouth, find the majority of minor salivary glands that are easy to biopsy. I don't know the skill and knowledge of the doctor, but having biopsied many individuals with sjogren's syndrome over my many years of practice, I have never had an inability to find a minor salivary gland. So, I am sorry to say this, but the doctor is not very knowledgeable where the minor salivary glands are abundant in everyone.
As far as the feel of the fat lip and dribbling, most likely the doctor cut a minor nerve in the area. That should get better on its own, but it could take a few months. If a more major nerve was cut, then it may not completely return. Of course, again I cannot tell without examining you.
I hate to tell you this news, but you should be aware. The doctor should be evaluating you frequently to determine the extent of nerve injury and the healing rate. I hope it all gets better, but the doctor should have informed you and should be following you.
if you have additional questions, feel free to contact me again.
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QUESTION: Sorry, my description was not clear. The first incision was behind the lower lip but closer to the gum line. The ENT said that she has done many incisions in that area for salivary gland biopsies and was very surprised that there were no glands. The second incision was also on the inside of the lower lip but higher up. What is the percentage of false negatives/false positives? I do have a follow up the end of this week.
Sorry for the confusion.
Roxy - Again, as I said the last time, a small incision in the lower list just behind the vermillion border (the drier part of the lower lip on the border of inside and outside of the lip). That is a location where a high percentage of minor salivary glands lie.
I am not sure what you are asking about that is false. If there is a gland found, the pathology lab can diagnose if the gland is a problem. So hopefully the ENT doctor really knows the glandular location.