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原文題目(出處)： A retrospective analysis of post-operative outcomes in a series of 108 labial gland biopsies(oral surgery)
原文作者姓名： S.Ali
通訊作者學校： Department of Oral Medicine, King’s College London and Guy’s & St. Thomas’ NHS Foundation Trust, London, UK
報告者姓名(組別)： 林典芸(H)
報告日期： 104.03.10
內文：
Introduction
1. Labial gland biopsy (LGB) is an important com-ponent in the diagnosis of Sjogren’s Syndrome
2. Sjogren’s syndrome ( SS) is a systemic autoimmune disease 3. initially targets primarily the lacrimal and salivary glands
4. keratoconjunctivitis sicca (dry eye disease) and/or stomatitis sicca (dry mouth disease)
5. The international collaboration into SS proposed new data-driven diagnostic criteria , at least 2
(1) positive serum anti-SSA and/or anti-SSB or positive rheumatoid factor and antinuclear antibody titre >1:320
(2) Keratoconjunctivitis sicca with ocular staining score>3
(3) presence of focal lymphocytic sialadenitis with a focus score>1 focus/4 mm 2 in labial salivary gland biopsy samples
6. Post-operative complications (1) post-operative pain (2) Paraesthesia (3) Haematoma (4) Swelling
(5) Lower lip numbness-occurring in 0–11.4% of patients
Clinical steps
1. Ensure that the patient is sitting in a calm environment and has been adequately consented and warned of serious or frequently occurring post-operative complications, Identify an area of mucosa of the lower lip that appears normal clinically and is not inflamed
2. Local anaesthetic is infiltrated into the sub-epithelial area that will be incised. The needle is inserted only once to a depth of 2 mm into the labial mucosa
口腔病理科
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3. A no.15 blade is used to make a 1.5–2.0 cm horizontal linear incision through the epithelium and not the underlying connective tissue.
4. Separation of incision margin creating an elliptical shape
5. Blunt dissection of lamina propria to release minor salivary glands and identify any nerve fibres
6. Approximately 6–8 minor salivary glands should be removed
7. Closure is achieved with two to four simple interruped resorbable sutures 8. Pressure is applied to the biopsy site to achieve hae-mostasis, and
post-operative instructions are given
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Post-operative morbidity and paraethesia survey
1. 180 patients, between Oct 2010 to Aug 2012,108 surveys were successful completed
2. The minimum length of time between the biopsy and the survey was 6 months,and the maximum time was 25 months
3. Pain that lasted >2 weeks, but <6 months was defined as a medium term or temporary post-operative complication
4. any pain that lasted ≥6 months was defined as long term or a permanent complication.
Results
1. 6 patients (5.5%) reported post-operative pain that lasted > 2 weeks with an average VAS pain score of 5
2. 6 out of the total 108 patients (5.5%) complained of post-operative swelling that lasted > 2 weeks
3. 8 out of the 108 patients (7.4%) reported some paraesthesia following biopsy
Discussion
1. Only one patient out of 108 patients (0.9%) reported pain that lasted ≥6 months
2. only six patients (5.5%) reported swell-ing that lasted >2 weeks 3. Permanent localised paraes-thesia occurred in three out of the 108
patients (2.8%)
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4. One disadvantage of a telephone survey is that results are purely a subjective measure of the patient’s reported symptoms, and physical examination cannot be conducted
5. the use of analgesia and non-steroidal inflammatory drugs as well as other medication that may affect post-operative pain and swelling was not taken into account
6. the interval between date of biopsy and date of telephone questionnaire varied from 6 months to 25 months and could have been standardised to ensure more accurate results
7. Greenspan et al . used a technique with a 1.5–2 cm linear incision of mucosa parallel to the vermillion border and lateral to midline, and the incidence of long-term paraesthesia in 75 patients was reported to be 1%.
8. Pijpe et al .used a technique involving a horizontal incision of 3 cm and reported the incidence temporary paraesthesia to be 11% and long-term paraesthesia to be 6% ( n = 35)
9. Santiagoet al .used a 2–3 mm horizontal incision, reporting a 7%
incidence of post-operative pain and 3% incidence of temporary paraesthesia but no permanent paraesthesia. ( n = 186)
10. Gorson and Ropper used a 1 cm vertical incision behind the wet line through mucosa and submucosa and reported one case of persistent numbness (2%)
11. Berquin et al . used an oblique incision, 1.5 cm from the midline
proceeding lateroinferiorly, avoiding the glandular free zone in the centre of the lower lip, with a 4% incidence of paraesthesia
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Conclusion
1. Labial gland biopsy has played an important role in SS-disease specificity, wide availability,minimal invasiveness and opportunity to assess
auto-immune disease-active cells within a Sjogren’s target organ
2. Labial gland biopsy remains a safe procedure with low complication rates 3. This article outlines a technique for labial gland biopsy which has proved
to be effective in delivering histopathological diagnosis and has a low level of post-operative complications
題號 題目
1 Which one of the following statement about Sjogren syndrome is wrong?
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(A) Is an autoimmune disease
(B) Principally involves the salivary and lacrimal glands (C) Has the gender prevalence of male
(D) Predominantly in middle-aged adults 答案
(C )
出處：oral and maxillofacial pathology
題號 題目
2 Following antibodies are shown in Sjogren syndrome except?
(A) Anti-SS-A (B) Anti-SS-B
(C) Rheumatoid factor (D) Anti-SS-C
答案 ( D)
出處：oral and maxillofacial pathology
