Name: A Lip Fixation Device Facilitates Labial Salivary Gland Biopsy for Sjögrens Disease (Video) | JoVE Journal
Uploaded: 2026-03-06T13:35:00.000+00:00
Duration: 5 min 23 s
Description: Learn a standardized, device-assisted labial salivary gland biopsy protocol for diagnosing Sjögren's disease. This method reduces procedure time while maintaining safety and diagnostic accuracy for clinicians.

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5 minutes

The study was conducted with complete transparency and adherence to ethical guidelines, supported by non-commercial funding from the National Natural Science Foundation of China (Grant No. 82371808) and the Natural Science Foundation of Guangdong Province (Grant No. 2023A1515011922), and Sun Yat-sen Pilot Scientific Research Fund (Grant No. YXQH202604). These funding bodies had no involvement in study design, data interpretation, or manuscript preparation.

This study was approved by the Medical Ethics Committee of Sun Yat-sen Memorial Hospital (approval no. SYSEC-KY-KS-2018-012). All procedures were performed in accordance with the principles of the Declaration of Helsinki.
1. Preparation (Figure 1)
<ol>
	<li>Prepare the following materials: Type III Povidone-Iodine Solution (0.45%~0.55% iodine, 0.09%~0.11% chlorhexidine gluconate; alcohol-free), a local anesthetic solution containing 2% (w/v) mepivacaine hydrochloride and epinephrine at a concentration of 1:100,000, a sterile fenestrated surgical drape, as well as sterile cotton balls and gauze.</li>
	<li>Prepare the following instruments: a scalpel handle and blade, a tissue forceps, small dissecting scissors, a needle holder, suture, and a 1-mL syringe (Figure 1A). The lip fixation device consists of two clamp arms, an oval pressure ring, a compatible oval backing plate, and a screw knob (Figure 2). The oval pressure ring has a major axis of approximately 2.4 cm and a minor axis of approximately 1.5 cm; a 2.1 cm gap separates the ring from the oval backing plate. Constructed from 18Cr stainless steel (containing 18 wt% chromium), the device is fully compatible with high-pressure steam sterilization.</li>
</ol>
2. Patient positioning
<ol>
	<li>Conduct the procedure in a standard medical treatment room. Position the patient supine on the bed. Ensure the patient is comfortable and the head is supported to minimize movement during the procedure.</li>
</ol>
3. Pre-operative assessment
<ol>
	<li>Perform clinical inspection.
	<ol>
		<li>Evaluate dentition and intraoral mucosa for signs of active infection (e.g., periodontal abscesses, severe gingivitis), severe oral mucosal erosion or ulceration, significant debris or plaque accumulation adjacent to the planned incision site, or any confirmed or suspected neoplastic or non-neoplastic mass lesions involving the lip region.</li>
	</ol>
	</li>
	<li>Perform a Go/No-Go assessment.
	<ol>
		<li>Defer the procedures in the presence of: (1) localized active infection; (2) severe oral mucosal erosion or ulceration; (3) significant debris or plaque accumulation adjacent to the planned incision site.</li>
		<li>Reschedule the procedure only after these findings are resolved. Postpone the biopsy if a mass lesion involving the lip region is identified, as such lesions require comprehensive evaluation and management by a qualified oral and maxillofacial surgeon or medical oncologist.</li>
	</ol>
	</li>
</ol>
4. Surgical field setup and anesthesia
<ol>
	<li>Place a cotton ball in the bucco-alveolar sulcus to absorb saliva and bleeding during the procedure.</li>
	<li>Perform triple disinfection of the intraoral mucosa, alveolar processes, teeth, perioral skin, and nasal region using Type III povidone-iodine solution.</li>
	<li>Don sterile surgical gloves. Establish a sterile field by applying the sterile, fenestrated surgical drape over the patient&#39;s face, exposing only the mouth area.</li>
	<li>Administer anesthesia.
	<ol>
		<li>Identify the planned incision site on the lower lip, located either to the left or right of the midline, within the transitional zone between the vermilion border and the labial vestibule.</li>
		<li>Administer local infiltration anesthesia into the region bounded by the mucobuccal fold and the buccal surface of the mandibular first premolar using a 1-mL syringe. 
		&#8203;NOTE: Direct injection into the planned incision site must be strictly avoided, as it may induce tissue edema and thereby significantly increase the technical complexity of subsequent dissection. This study did not use a fixed anesthetic volume; instead, the anesthetic was administered slowly, beginning with an initial dose of approximately 0.4 mL and assessing for loss of sensation at the planned incision site before proceeding. This volume was typically sufficient to achieve adequate anesthesia for the biopsy procedure.</li>
		<li>Allow 5 min for the anesthetic to take effect before proceeding to the next step. 
		&#8203;NOTE: In select cases involving heightened tissue sensitivity, the total volume was increased incrementally, as needed, up to 0.8-1.0 mL.</li>
	</ol>
	</li>
</ol>
5. Stabilization
<ol>
	<li>Position the device.
	<ol>
		<li>Evert the lower lip to fully expose the surgical site. Separate the clamp arms of the fixation device. Orient the major axis of the oval pressure ring perpendicular to the vermilion border (Figure 1B).</li>
		<li>Position the backing plate against the labial skin and align the oval pressure ring with the intraoral labial mucosa, ensuring that the lip tissue is centered directly over the planned incision site. 
		NOTE: The major axis of the oval pressure ring must not be aligned parallel to the vermilion border, as such orientation may impede surgical access and restrict the incision length to no more than 2 mm (Figure 1C).</li>
	</ol>
	</li>
	<li>Secure the device.
	<ol>
		<li>The device employs a precision screw-driven clamping mechanism. Rotate the screw to apply a uniform compressive force through the oval ring to stabilize the lip during LSGB. Ensure the device is tightened appropriately. 
		&#8203;NOTE: Do not leave the device too loose, as this will result in inadequate stabilization and impede the surgical procedure.</li>
	</ol>
	</li>
</ol>
6. Incision and dissection
<ol>
	<li>Make a linear incision (5-7 mm in length) through the mucosa, oriented parallel to the major axis of the oval pressure ring (Figure 1D). Control the depth of the incision to penetrate the epithelium but strictly avoid damaging the underlying glands or deep muscle fibers.</li>
	<li>Insert the tips of the tissue forceps vertically into the incision. Gently separate the submucosal connective tissue using the tips to carefully tease apart the loose fibrous layers surrounding the glands.</li>
	<li>Upon dissection, identify the gland. The labial salivary glands appear as discrete, pale-yellow, translucent spherules (1-2 mm in diameter) with well-defined margins.</li>
	<li>Gently grasp the pedicle (the fibrous connection to the mucosa) using fine tissue forceps. Apply gentle traction to elevate the gland, then perform blunt dissection by separating the pedicle from surrounding tissue with the forceps alone. Avoid sharp dissection techniques, such as scissor-based or electrocautery methods, to preserve histopathological integrity.</li>
	<li>Collect the specimen.
	<ol>
		<li>Harvest a minimum of 4 to 6 labial salivary glands to ensure sufficient tissue for histopathological analysis.</li>
		<li>Place the excised glands immediately into the designated specimen container (e.g., 10% neutral buffered formalin). 
		&#8203;NOTE: In cases of suboptimal glandular yield, blunt dissection may be extended into the lateral submucosal space adjacent to the incision without enlarging the incision, which is maintained at a length of 5-7 mm.</li>
	</ol>
	</li>
</ol>
7. Closure and hemostasis
<ol>
	<li>Loosen the screw knob and carefully remove the fixation device from the lower lip. 
	NOTE: In cases where post-removal bleeding obscures the suture field during wound closure, direct pressure applied with gauze achieves rapid and effective hemostasis.</li>
	<li>Anatomically approximate the wound edges. Close the incision using a single simple interrupted suture (Figure 1E). 
	NOTE: Due to the limited length of the incision (5-7 mm), one suture is typically sufficient to achieve adequate closure.</li>
	<li>Apply gentle digital pressure with a sterile cotton ball to the closed wound for 1-2 min to ensure final hemostasis.</li>
	<li>Instruct the patient to maintain oral hygiene and to return to the clinic 7 days post-operatively for suture removal and wound evaluation.</li>
</ol>

<ol><li>Ramos-Casals, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((2023+International+Rome+consensus+for+the+nomenclature+of+Sj%C3%B6gren+disease%5BTitle%5D)+AND+%22Nat+Rev+Rheumatol%22%5BJournal%5D)">2023 International Rome consensus for the nomenclature of Sjögren disease.</a> Nat Rev Rheumatol. 21 (7), 426-437 (2025).</li>
<li>Vitali, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Classification+criteria+for+Sj%C3%B6gren%27s+syndrome%3A+a+revised+version+of+the+European+criteria+proposed+by+the+American-European+Consensus+Group%5BTitle%5D)+AND+%22Ann+Rheum+Dis%22%5BJournal%5D)">Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group.</a> Ann Rheum Dis. 61 (6), 554-558 (2002).</li>
<li>Shiboski, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((American+College+of+Rheumatology+classification+criteria+for+Sj%C3%B6gren%27s+syndrome%3A+a+data-driven%2C+expert+consensus+approach+in+the+Sj%C3%B6gren%27s+International+Collaborative+Clinical+Alliance+cohort%5BTitle%5D)+AND+%22Arthritis+Care+Res+%28Hoboken%29%22%5BJournal%5D)">American College of Rheumatology classification criteria for Sjögren's syndrome: a data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance cohort.</a> Arthritis Care Res (Hoboken). 64 (4), 475-487 (2012).</li>
<li>Shiboski, C. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((2016+American+College+of+Rheumatology%2FEuropean+League+Against+Rheumatism+Classification+Criteria+for+Primary+Sj%C3%B6gren%27s+Syndrome%3A+A+consensus+and+data-driven+methodology+involving+three+international+patient+cohorts%5BTitle%5D)+AND+%22Arthritis+Rheumatol%22%5BJournal%5D)">2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A consensus and data-driven methodology involving three international patient cohorts.</a> Arthritis Rheumatol. 69 (1), 35-45 (2017).</li>
<li>Price, E. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((British+Society+for+Rheumatology+guideline+on+management+of+adult+and+juvenile+onset+Sj%C3%B6gren+disease%5BTitle%5D)+AND+%22Rheumatology+%28Oxford%29%22%5BJournal%5D)">British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease.</a> Rheumatology (Oxford). 64 (2), 409-439 (2025).</li>
<li>Li, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Surgical+advantage+of+modified+labial+salivary+gland+biopsy+using+chalazion+forceps%3A+a+prospective+randomized+controlled+study%5BTitle%5D)+AND+%22Clin+Exp+Med%22%5BJournal%5D)">Surgical advantage of modified labial salivary gland biopsy using chalazion forceps: a prospective randomized controlled study.</a> Clin Exp Med. 24 (1), 175(2024).</li>
<li>Varela-Centelles, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Minor+salivary+gland+biopsy+in+Sj%C3%B6gren%27s+syndrome%3A+a+review+and+introduction+of+a+new+tool+to+ease+the+procedure%5BTitle%5D)+AND+%22Med+Oral+Patol+Oral+Cir+Bucal%22%5BJournal%5D)">Minor salivary gland biopsy in Sjögren's syndrome: a review and introduction of a new tool to ease the procedure.</a> Med Oral Patol Oral Cir Bucal. 19 (1), e20-e23 (2014).</li>
<li>Wijaya, C., Ramli, R. R., Khoo, S. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Dry+surgical+field+minor+salivary+gland+harvest+using+a+chalazion+clamp+for+sicca+syndrome%5BTitle%5D)+AND+%22J+Laryngol+Otol%22%5BJournal%5D)">Dry surgical field minor salivary gland harvest using a chalazion clamp for sicca syndrome.</a> J Laryngol Otol. 133 (5), 419-423 (2019).</li>
<li>Wo, S. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Neuroanastomosis+and+the+innervation+territory+of+the+mental+nerve%5BTitle%5D)+AND+%22Clin+Anat%22%5BJournal%5D)">Neuroanastomosis and the innervation territory of the mental nerve.</a> Clin Anat. 27 (4), 598-602 (2014).</li>
<li>Teppo, H., Revonta, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+follow-up+study+of+minimally+invasive+lip+biopsy+in+the+diagnosis+of+Sj%C3%B6gren%27s+syndrome%5BTitle%5D)+AND+%22Clin+Rheumatol%22%5BJournal%5D)">A follow-up study of minimally invasive lip biopsy in the diagnosis of Sjögren's syndrome.</a> Clin Rheumatol. 26, 1099-1103 (2007).</li>
<li>Fisher, B. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Standardisation+of+labial+salivary+gland+histopathology+in+clinical+trials+in+primary+Sjogren%27s+syndrome%5BTitle%5D)+AND+%22Ann+Rheum+Dis%22%5BJournal%5D)">Standardisation of labial salivary gland histopathology in clinical trials in primary Sjogren's syndrome.</a> Ann Rheum Dis. 76 (7), 1161-1168 (2017).</li>
<li>Tryposkiadis, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Increasing+the+number+of+minor+salivary+glands+from+patients+with+Sj%C3%B6gren%27s+disease+improves+the+diagnostic+and+measurement+precision+of+the+histological+focus+score%5BTitle%5D)+AND+%22Ann+Rheum+Dis%22%5BJournal%5D)">Increasing the number of minor salivary glands from patients with Sjögren's disease improves the diagnostic and measurement precision of the histological focus score.</a> Ann Rheum Dis. 84 (4), 601-608 (2025).</li>
<li>Ike, R. W., McCoy, S. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Bedside+labial+salivary+gland+biopsy+%28LSGBx%3A+Lip+biopsy%29%3A+An+update+for+rheumatologists%5BTitle%5D)+AND+%22Best+Pract+Res+Clin+Rheumatol%22%5BJournal%5D)">Bedside labial salivary gland biopsy (LSGBx: Lip biopsy): An update for rheumatologists.</a> Best Pract Res Clin Rheumatol. 37 (1), 101839(2023).</li>
<li>Dumusc, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Use+of+a+smart+lip+holder+for+minimally+invasive+minor+salivary+gland+biopsy%5BTitle%5D)+AND+%22BMJ+Innov%22%5BJournal%5D)">Use of a smart lip holder for minimally invasive minor salivary gland biopsy.</a> BMJ Innov. 7, 445-447 (2021).</li>
</ol>

All authors declare that there are no conflicts of interest pertaining to this study. Specifically, Jia-Zhe Li, Jun-Mei Feng, Hong Lan, Lie Dai, Zhi-Ming Ouyang, and Ying-Qian Mo affirm that they have no financial or personal relationships with any organizations or entities that could unduly influence or bias the research presented in this manuscript. The lip fixation device described in this study was developed exclusively for research purposes and is devoid of any commercial affiliations or financial incentives for the authors. None of the authors holds patents, stocks, or receives royalties related to the device; furthermore, there are no competing interests concerning its clinical application. All authors contributed intellectually to this work without any external pressures or influences that could constitute a conflict of interest.

The success of our lip fixation device-assisted LSGB technique depends on several critical procedural steps. First and foremost, precise device positioning is critical. Orient the major axis of the oval pressure ring perpendicular to the vermilion border, and align the vertical incision (5-7 mm in length) parallel to the major axis of the pressure plate to ensure optimal surgical exposure and effective compression-induced hemostasis. Conversely, aligning the incision along the minor axis of the pressure plate compromises...

Sj&#246;gren&#39;s disease (SjD) is a chronic autoimmune disorder characterized by lymphocytic infiltration of exocrine glands, particularly the salivary glands, leading to progressive glandular dysfunction and xerostomia1. Over the years, multiple classification criteria for SjD have consistently designated focal lymphocytic sialadenitis, identified histologically by labial salivary gland biopsy (LSGB), as a key diagnostic criterion2,3,4. This histopathological feature demonstrates higher specificity than subjective clinical manifestations such as xerostomia, particularly in patients with suspected SjD when serological markers (e.g., anti-SSA/Ro) or other clinical features are equivocal or absent. In addition to its established role in diagnostic classification, LSGB provides clinically relevant prognostic information, most notably regarding the risk of lymphoma development, applicable to both seronegative and seropositive patients5. However, LSGB remains technically challenging, particularly for junior rheumatologists, due to factors such as the inherent slipperiness of the labial mucosa. Conventional manual lip retraction often requires either an additional operator or patient cooperation, which considerably complicates the procedure.
To ensure mechanical stabilization of the everted lip and achieve controlled, localized tissue compression, a dedicated clamping device was utilized. This lip fixation device comprises a pressure ring and a backing plate, both rigidly stabilized by a precision screw mechanism, enabling uniform and precisely adjustable compression while effectively immobilizing the everted lip during labial salivary gland biopsy. Compared with conventional LSGB methods, the proposed device-assisted approach reduces procedure time, provides consistent compression with minimal bleeding, reduces inter-operator variability, and offers a more accessible and reproducible technique-rendering it especially suitable for junior clinicians, solo practitioners, and resource-constrained settings where assistant support is limited or unavailable.

<table><tbody><tr><td>Blade</td><td>Shanghai jinghuan medicial&amp;nbsp;</td><td>20212020337</td><td></td></tr><tr><td>Gauze</td><td>Winner medical Co., Ltd</td><td>20140001</td><td></td></tr><tr><td>Lip Fixation Device</td><td>Cnstrong</td><td>9CM-large</td><td>Material Specifications 18Cr&quot; (18% Chromium stainless steel)&lt;br/&gt; Disinfection method: High-pressure steam sterilization</td></tr><tr><td>Needle holder</td><td>Geister Medical Co., Ltd.</td><td>20121010135</td><td></td></tr><tr><td>Scalpel handle</td><td>Shanghai Medical Devices (Group) Co., Ltd. Surgical Instrument Factory</td><td>20121010945</td><td></td></tr><tr><td>Scandonest</td><td>Septodont</td><td>86978859000048</td><td>containing 2% (w/v) mepivacaine hydrochloride and epinephrine at a concentration of 1:100,000</td></tr><tr><td>Small dissecting scissors</td><td>Alcon&amp;nbsp;Laboratories, Inc.</td><td>20172041227</td><td></td></tr><tr><td>Sterile cotton balls</td><td>Qingdao Aibaze Medical Co., Ltd.</td><td>20150153</td><td></td></tr><tr><td>Sterile fenestrated surgical drape</td><td>Nanchang Tongda Medical Devices Co., Ltd.</td><td>20202140426</td><td></td></tr><tr><td>Suture</td><td>Hangzhou huawei medical supples Co.,LTD</td><td>20142020178</td><td></td></tr><tr><td>Syringe (1 mL)</td><td>Shandong Weigao Group Medical Polymer Products Co., Ltd.</td><td>20163141593</td><td></td></tr><tr><td>Tissue forceps</td><td>Shanghai Medical Devices (Group) Co., Ltd. Surgical Instrument Factory</td><td>20051010331</td><td></td></tr><tr><td>Type III Povidone-Iodine Solution</td><td>Winner medical Co., Ltd</td><td>20150209</td><td>0.45%&amp;ndash;0.55% iodine, 0.09%&amp;ndash;0.11% chlorhexidine gluconate; alcohol-free</td></tr></tbody></table>

a lip fixation device facilitates labial salivary gland biopsy for sj&#246;gren's disease

A Lip Fixation Device Facilitates Labial Salivary Gland Biopsy for Sj&#246;gren's Disease

The protocol aims to standardize and simplify labial salivary gland biopsy (LSGB) in suspected Sj&#246;gren&#39;s disease (SjD) using a lip fixation device, enabling safe, efficient, and operator-independent procedures with reduced technical difficulty, especially for junior rheumatologists. We developed a step-by-step protocol encompassing preoperative assessment, antisepsis, local anesthesia, device-assisted lip stabilization, precise vertical incision (5-7 mm), blunt dissection, gland harvesting (minimum 4-6 glands), and standardized closure. The device consists of two clamp arms, an oval pressure ring (major axis 2.4 cm, minor axis 1.5 cm), a matching backing plate separated by a 2.1 cm gap, and a precision screw mechanism. After the patient was positioned supine on the bed, clinical inspection was performed, followed by a &#34;go/no-go&#34; assessment to exclude localized active infection, mucosal ulceration, significant debris, or lip masses. Triple antisepsis is performed with alcohol-free Type III povidone-iodine. Local infiltration anesthesia is administered away from the incision site. The lip is everted and stabilized by the device; a vertical incision is made parallel to the pressure ring axis, penetrating the epithelium while avoiding deep glands or muscle. Glands are identified as pale-yellow translucent spherules (1-2 mm) and harvested by blunt dissection. Closure is achieved with a single interrupted suture, and hemostasis is verified. The protocol enables solo performance, reduces procedure time compared with conventional methods (8.72 &#177; 1.88 min vs. 18.11 &#177; 2.65 min, p &#60; 0.001), yields comparable complication rates between groups (all p &#62; 0.05), and ensures acquisition of adequate tissue (&#62;8 mm&#178;, focus score assessment feasible). The device&#39;s elastic compression prevents tissue injury despite secure stabilization, and predefined troubleshooting steps manage bleeding or suboptimal yield. This protocol standardizes LSGB with a fixation device, overcoming manual retraction challenges, reducing reliance on assistants, and supporting training and quality assurance in rheumatology, while maintaining diagnostic accuracy and patient safety.

A prospective study was conducted among 470 patients with suspected SjD who underwent LSGB, approved by the Medical Ethics Committee of Sun Yat-sen Memorial Hospital. The cohort comprised 443 women (94%) with a mean age of 45.8 ± 14.5 years, who underwent LSGB utilizing the lip fixation device from October 2020 to June 2025. Among the cohort, 279 patients (59.3%) exhibited a labial focus score (FS) of ≥1, with all biopsy sample areas measuring greater than 8 mm², demonstrating the reliability of the protocol in obtaining...

This protocol outlines the methodology for utilizing a lip fixation device in labial salivary gland biopsy, along with its associated advantages.

The protocol aims to standardize and simplify labial salivary gland biopsy (LSGB) in suspected Sj&#246;gren&#39;s disease (SjD) using a lip fixation ...

This study uses a new type of lip fixation device to simplify the biopsy for Sjogren's syndrome, thereby enhancing the safety and efficiency of the surgery. Traditional methods for performing this procedure require assistance. The device used in this protocol securely stabilizes the mucosa, enabling clinicians to perform the procedure independently.To begin, position the patient's supine on the bed, place a cotton ball in the bucco alveolar sulcus to absorb saliva and bleeding during the procedure. Perform triple disinfection of the intraoral mucosa, alveolar processes, teeth, perioral skin, and nasal region using type-three povidone-iodine solution. Now, don sterile surgical gloves, establish a sterile field by applying the sterile fenestrated surgical drape over the patient's face and expose only the mouth area.Identify the planned incision site on the lower lip located either to the left or right of the midline within the transitional zone between the vermilion border and the labial vestibule. Administer local infiltration anesthesia into the region, bounded by the mucobuccal fold and the buccal surface of the mandibular first premolar using a one milliliter syringe. Five minutes after the anesthetic injection, evert the lower lip to fully expose the surgical site.Separate the clamp arms of the fixation device. Orient the major axis of the oval pressure ring perpendicular to the vermilion border. Position the backing plate against the labial skin.Align the oval pressure ring with the intraoral labial mucosa, ensuring that the lip tissue is centered directly over the planned incision site. Now rotate the screw to apply a uniform compressive force through the oval ring to stabilize the lip during the procedure. Ensure the device is tightened appropriately.Make a linear incision five to seven millimeters in length through the mucosa oriented parallel to the major axis of the oval pressure ring. Avoiding damage to the underlying glands or deep muscle fibers. Insert the tips of the tissue forceps vertically into the incision.Gently separate the submucosal connective tissue to tease apart the loose fibrous layers surrounding the glands. While grasping the pedicle. Apply gentle traction to elevate the gland and perform blunt dissection by separating the pedicle from surrounding tissue with the forceps alone.Avoiding sharp dissection, harvest a minimum of four to six labial salivary glands to ensure sufficient tissue. for histopathological analysis. Loosen the screw knob and carefully remove the fixation device from the lower lip.Apply direct pressure with gauze to achieve hemostasis, if bleeding, obscures the suture field during wound closure, anatomically approximate the wound edges and close the incision using a single simple interrupted suture. Apply gentle digital pressure with a sterile cotton ball to the closed wound for one to two minutes to ensure final hemostasis. A comparative study of device assisted versus conventional labial salivary gland biopsy was conducted.Procedure time was significantly shorter with the device-assisted technique compared to the conventional technique. Complication rates, including pain, hematoma, and sensory impairment were not significantly different between the two groups. Indicating that the improved efficiency does not compromise safety.This protocol consistently yields adequate labial gland tissue helping researchers accurately evaluate the focus score. The critical challenge is positioning the pressure ring perpendicular to the vermilion border to ensure optimal surgical exposure. Future work can optimize the device using 3D printing and facilitate multicenter clinical studies and structured training programs.

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Salivary gland ultrasonography is a promising tool for the diagnosis and evaluation of disease activity and complications in Sjogren's syndrome (SS). The scanning technique for salivary gland ultrasound examination relevant to SS is described in the article.

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Learn a standardized, device-assisted labial salivary gland biopsy protocol for diagnosing Sjögren's disease. This method reduces procedure time while maintaining safety and diagnostic accuracy for clinicians.

A Lip Fixation Device Facilitates Labial Salivary Gland Biopsy for Sjögren's Disease

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